Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy
Screening for colorectal cancer: randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy
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DOI：
10.1136/gut.2009.177089
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发表时间：
2010-01-01
期刊：
影响因子：
24.5
通讯作者：
Kuipers, E. J.
中科院分区：
文献类型：
--
作者：
Hol, L.;van Leerdam, M. E.;Kuipers, E. J.
背景：结直肠癌(CRC)筛查已被广泛接受，但对首选策略尚无共识。我们进行了一项随机试验，比较了以愈创木为基础的粪便潜血试验(GFOBt)、免疫化学FOBT(FIT)和柔性乙状结肠镜(FS)用于结直肠癌筛查的每个筛查对象的参与率和检测率(DR)。方法：在邀请参加三种筛查策略之一之前，荷兰人群中具有代表性的样本(n=15011)被随机分为1：1：1。结肠镜检查适用于gFOBt或FIT阳性的筛查，以及FS显示直径=10 mm的息肉；腺瘤直径=10 mm；腺瘤=25%绒毛成分或高度不典型增生；锯齿状腺瘤；=3个腺瘤；结果：gFOBt的参与率为49.5%(95%可信区间为48.1~50.9%)，FIT为61.5%(CI为60.1~62.9%)，FS筛查为32.4%(CI为31.1%~33.7%)。GFOBt阳性率为2.8%，FIT为4.8%，FS为10.2%。晚期肿瘤的DR在FIT组(2.4%；OR，2.0；CI，1.3~3.1)和FS组(8.0%；OR，7.0；CI，4.6~10.7)显著高于gFOBt组(1.1%)。每100名受邀者中，FS对晚期肿瘤的诊断率(2.4；CI，2.0~2.8)高于gFOBt(0.6；CI，0.4~0.8)或FIT筛查(1.5；CI，1.2~1.9)。结论：与gFOBt筛查相比，这项基于人群的随机CRC筛查试验显示出更高的FIT参与率和检测率。因此，Fit筛查应该比gFOBt筛查更受欢迎。FS筛查显示，每100名受邀者的诊断率高于两种FOBT。
Background: Screening for colorectal cancer (CRC) is widely accepted, but there is no consensus on the preferred strategy. We conducted a randomised trial comparing participation and detection rates (DR) per screenee of guaiac-based faecal occult blood test (gFOBT), immunochemical FOBT (FIT), and flexible sigmoidoscopy (FS) for CRC screening.Methods: A representative sample of the Dutch population (n = 15 011), aged 50-74 years, was 1: 1: 1 randomised prior to invitation to one of the three screening strategies. Colonoscopy was indicated for screenees with a positive gFOBT or FIT, and for those in whom FS revealed a polyp with a diameter >= 10 mm; adenoma with >= 25% villous component or high grade dysplasia; serrated adenoma; >= 3 adenomas; >= 20 hyperplastic polyps; or CRC.Results: The participation rate was 49.5% (95% confidence interval (CI) 48.1 to 50.9%) for gFOBT, 61.5% (CI, 60.1 to 62.9%) for FIT and 32.4% (CI, 31.1 to 33.7%) for FS screening. gFOBT was positive in 2.8%, FIT in 4.8% and FS in 10.2%. The DR of advanced neoplasia was significantly higher in the FIT (2.4%; OR, 2.0; CI, 1.3 to 3.1) and the FS arm (8.0%; OR, 7.0; CI, 4.6 to 10.7) than the gFOBT arm (1.1%). FS demonstrated a higher diagnostic yield of advanced neoplasia per 100 invitees (2.4; CI, 2.0 to 2.8) than gFOBT (0.6; CI, 0.4 to 0.8) or FIT (1.5; CI, 1.2 to 1.9) screening.Conclusion: This randomised population-based CRC-screening trial demonstrated superior participation and detection rates for FIT compared to gFOBT screening. FIT screening should therefore be strongly preferred over gFOBT screening. FS screening demonstrated a higher diagnostic yield per 100 invitees than both FOBTs.