Effectiveness of fecal immunochemical testing in reducing colorectal cancer mortality from the One Million Taiwanese Screening Program.
Effectiveness of fecal immunochemical testing in reducing colorectal cancer mortality from the One Million Taiwanese Screening Program.
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DOI：
10.1002/cncr.29462
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发表时间：
2015-09-15
期刊：
影响因子：
6.2
通讯作者：
Chiou ST
中科院分区：
文献类型：
--
作者：
Chiu HM;Chen SL;Yen AM;Chiu SY;Fann JC;Lee YC;Pan SL;Wu MS;Liao CS;Chen HH;Koong SL;Chiou ST
粪便免疫化学检测（FIT）在降低结直肠癌（CRC）死亡率方面的有效性尚未在一个大型的、以人群为基础的服务筛查项目中得到充分评估。在2004年至2009年期间，对约500万台湾人进行了一项前瞻性队列研究，以比较暴露（筛查）组和未暴露（未筛查）组的CRC死亡率，该研究以台湾50至69岁的社区居民为目标，以人群为基础进行CRC筛查服务。鉴于临床能力，这一全国性筛查方案于2004年首次推出。截至2009年，共有1，160，895例50 - 69岁的合格受试者（即，基础人群5，417，699例受试者的21.4%）参加了两年一次的全国筛查项目。FIT筛查降低CRC死亡率的实际有效性为62%（筛查组与未筛查组的相对比率为0.38; 95%置信区间为0.35-0.42），最长随访时间为6年。接受FIT的人群的21.4%的覆盖率导致CRC死亡率在自我选择偏倚调整后显著降低10%（相对率，0.90; 95%置信区间，0.84-0.95）。这个大型的，前瞻性的台湾队列接受了基于人群的FIT筛查CRC，具有统计学把握度来证明CRC死亡率显著降低，尽管随访时间很短。虽然这些发现为卫生决策者提供了信息，但如果覆盖人群扩大，则需要对这一大型队列进行持续随访，以估计FIT筛查的长期影响。Cancer 2015;121：3221-3229.© 2015美国癌症协会。粪便免疫化学检测可显著降低结直肠癌死亡率，这一点已被一项大型的、以人群为基础的、最长随访时间为6年的全国性服务筛查项目所证实。虽然这项全国性服务筛查计划需要长期随访，但这些发现有助于说服卫生决策者，继续推广这种全国性筛查计划是值得的。
The effectiveness of fecal immunochemical testing (FIT) in reducing colorectal cancer (CRC) mortality has not yet been fully assessed in a large, population-based service screening program. A prospective cohort study of the follow-up of approximately 5 million Taiwanese from 2004 to 2009 was conducted to compare CRC mortality for an exposed (screened) group and an unexposed (unscreened) group in a population-based CRC screening service targeting community residents of Taiwan who were 50 to 69 years old. Given clinical capacity, this nationwide screening program was first rolled out in 2004. In all, 1,160,895 eligible subjects who were 50 to 69 years old (ie, 21.4% of the 5,417,699 subjects of the underlying population) participated in the biennial nationwide screening program by 2009. The actual effectiveness in reducing CRC mortality attributed to the FIT screening was 62% (relative rate for the screened group vs the unscreened group, 0.38; 95% confidence interval, 0.35-0.42) with a maximum follow-up of 6 years. The 21.4% coverage of the population receiving FIT led to a significant 10% reduction in CRC mortality (relative rate, 0.90; 95% confidence interval, 0.84-0.95) after adjustments for a self-selection bias. This large, prospective Taiwanese cohort undergoing population-based FIT screening for CRC had the statistical power to demonstrate a significant CRC mortality reduction, although the follow-up time was short. Although such findings are informative for health decision makers, continued follow-up of this large cohort will be required to estimate the long-term impact of FIT screening if the covered population is expanded. Cancer 2015;121:3221–3229. © 2015 American Cancer Society. A significant reduction in colorectal cancer mortality resulting from fecal immunochemical testing is demonstrated by a large, population-based, nationwide service screening program with a maximum follow-up of 6 years. Although long-term follow-up of this nationwide service screening program is required, these findings are useful for convincing health decision makers that the continuous promotion of such a nationwide screening program is worthwhile.