Low-Dose Aspirin Use and Performance of Immunochemical Fecal Occult Blood Tests
Low-Dose Aspirin Use and Performance of Immunochemical Fecal Occult Blood Tests
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DOI：
10.1001/jama.2010.1773
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发表时间：
2010-12-08
影响因子：
120.7
通讯作者：
Haug, Ulrike
中科院分区：
文献类型：
--
作者：
Brenner, Hermann;Tao, Sha;Haug, Ulrike
免疫化学粪便潜血试验（iFOBTs）是潜在的大肠癌筛查工具。使用低剂量阿司匹林会增加消化道出血的可能性，这在结直肠癌筛查的目标人群中很常见。目的评估在接受结直肠癌筛查的大样本患者中，低剂量阿司匹林使用与2种定量iFOBTs表现的关系。2005年至2009年在德国南部的内科和胃肠病学实践中进行的诊断研究，包括1979名患者（平均年龄62.1岁）：233名经常使用低剂量阿司匹林的患者（167名男性，67名女性）和1746名从未使用低剂量阿司匹林的患者（809名男性，937名女性）。2个定量iFOBTs检测晚期结直肠肿瘤（结直肠癌或晚期腺瘤）的敏感性、特异性、阳性预测值和阴性预测值以及受试者工作特征（ROC）曲线下面积。结果低剂量阿司匹林服用者24例（10.3%），非服用者181例（10.4%）出现晚期肿瘤。在制造商推荐的临界值处，用户的敏感度为70.8%(95%可信区间[CI]， 48.9%-87.4%)，而非用户的敏感度为35.9% (95% CI, 28.9%-43.4%)；用户的敏感度为58.3% (95% CI, 36.6%-77.9%)，而非用户的敏感度为32.0% (95% CI, 25.3%-39.4%) （P= 0.001和P= 0.01）。使用者的特异性为85.7% (95% CI, 80.2%-90.1%)，而非使用者的特异性为89.2% (95% CI, 87.6%-90.7%)；使用者的特异性为85.7% (95% CI, 80.2%-90.1%)，而非使用者的特异性为91.1% (95% CI, 89.5%-92.4%) （P= 0.13和P= 0.01）。使用者的ROC曲线下面积为0.79 (95% CI, 0.68-0.90)，非使用者的为0.67 (95% CI, 0.62-0.71)；使用者的为0.73 (95% CI, 0.62-0.85)，非使用者的为0.65 (95% CI, 0.61-0.69) （P= 0.05和P= 0.17）。在男性中，低剂量阿司匹林服用者占大多数，服用者的ROC曲线下面积为0.87 (95% CI, 0.76-0.98)，而非服用者为0.68 (95% CI, 0.63-0.74)，服用者为0.81 (95% CI, 0.68-0.93)，非服用者为0.67 (95% CI, 0.61-0.72) （P= 0.003和P= 0.04）。结论：对于2例iFOBTs，使用低剂量阿司匹林与不使用阿司匹林相比，在检测晚期结直肠肿瘤方面具有明显更高的敏感性，仅特异性略低。《美国医学协会杂志》上。2010年;304 (22): 2513 - 2520 www.jama.com
Context Immunochemical fecal occult blood tests (iFOBTs) are potentially promising tools for colorectal cancer screening. Low-dose aspirin use, which increases the likelihood of gastrointestinal bleeding, is common in the target population for colorectal cancer screening.Objective To assess the association of low-dose aspirin use with the performance of 2 quantitative iFOBTs in a large sample of patients undergoing colorectal cancer screening.Design, Setting, and Participants Diagnostic study conducted from 2005 through 2009 at internal medicine and gastroenterology practices in southern Germany including 1979 patients (mean age, 62.1 years): 233 regular users of low-dose aspirin (167 men, 67 women) and 1746 who never used low-dose aspirin (809 men, 937 women).Main Outcome Measures Sensitivity, specificity, positive and negative predictive values, and area under receiver operating characteristic (ROC) curves in detecting advanced colorectal neoplasms (colorectal cancer or advanced adenoma) with 2 quantitative iFOBTs.Results Advanced neoplasms were found in 24 users (10.3%) and 181 nonusers (10.4%) of low-dose aspirin. At the cut point recommended by the manufacturer, sensitivities of the 2 tests were 70.8% (95% confidence interval [CI], 48.9%-87.4%) for users compared with 35.9% (95% CI, 28.9%-43.4%) for nonusers and 58.3% (95% CI, 36.6%-77.9%) for users compared with 32.0% (95% CI, 25.3%-39.4%) for nonusers (P=.001 and P=.01, respectively). Specificities were 85.7% (95% CI, 80.2%-90.1%) for users compared with 89.2% (95% CI, 87.6%-90.7%) for nonusers and 85.7% (95% CI, 80.2%-90.1%) for users compared with 91.1% (95% CI, 89.5%-92.4%) for nonusers (P=.13 and P=.01, respectively). The areas under the ROC curve were 0.79 (95% CI, 0.68-0.90) for users compared with 0.67 (95% CI, 0.62-0.71) for nonusers and 0.73 (95% CI, 0.62-0.85) for users compared with 0.65 (95% CI, 0.61-0.69) for nonusers (P=.05 and P=.17, respectively). Among men, who composed the majority of low-dose aspirin users, the areas under the ROC curve were 0.87 (95% CI, 0.76-0.98) for users compared with 0.68 (95% CI, 0.63-0.74) for nonusers and 0.81 (95% CI, 0.68-0.93) for users compared with 0.67 (95% CI, 0.61-0.72) for nonusers (P=.003 and P=.04, respectively).Conclusion For 2 iFOBTs, use of low-dose aspirin compared with no aspirin was associated with a markedly higher sensitivity for detecting advanced colorectal neoplasms, with only a slightly lower specificity. JAMA. 2010;304(22):2513-2520 www.jama.com