Influence of Varying Quantitative Fecal Immunochemical Test Positivity Thresholds on Colorectal Cancer Detection: A Community-Based Cohort Study.
Influence of Varying Quantitative Fecal Immunochemical Test Positivity Thresholds on Colorectal Cancer Detection: A Community-Based Cohort Study.
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DOI：
10.7326/m18-0244
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发表时间：
2018-10-02
影响因子：
39.2
通讯作者：
Corley DA
中科院分区：
文献类型：
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作者：
Selby K;Jensen CD;Lee JK;Doubeni CA;Schottinger JE;Zhao WK;Chubak J;Halm E;Ghai NR;Contreras R;Skinner C;Kamineni A;Levin TR;Corley DA
粪便免疫化学试验（FIT）通常用于结直肠癌（CRC）筛查。尽管粪便血红蛋白浓度存在人口统计学差异，但关于年龄和性别的最佳阳性阈值的数据很少。确定程序（多测试）FIT性能特征和最佳FIT定量血红蛋白阳性阈值在大型，以人群为基础的筛选程序。回顾性队列研究Kaiser Permanente北加州和南加州50-75岁的成年人，筛选合格，基线定量FIT结果（2013-2014），随访2年。近三分之二（411,641）在2年内有过FIT。FIT对结直肠癌的程序敏感性和每检出癌症的阳性检测数，总体和按年龄和性别分列。在完成基线FIT并随访2年的640,859人中，481,817人（75%）有≥1个额外FIT， 1245人（0.19%）被诊断为结直肠癌。在较低的阳性阈值下，癌症检出率（程序灵敏度）增加，从30 μg/g时的925/1,245(74.3%)，到20 μg/g时的950（76.3%）和10 μg/g时的987 (79.3%)；每一种癌症的阳性检测数从30 μg/g时的43例增加到20 μg/g时的52例，10 μg/g时的85例。将阳性阈值从20 μg/g降低到15 μg/g，将使癌症检出率增加3%，结肠镜检查次数增加23%。在常规20 μg/g FIT阈值下，程序敏感性随年龄的增加而降低（50-59岁、60-69岁和70-75岁分别为79.0%、73.4%和68.9%,p=0.009），且男性高于女性（77.0%比70.6%,p=0.011）。缺乏关于晚期腺瘤的信息。在较低阳性阈值下增加的癌症检测被阳性检测的大量增加所抵消。根据当地资源，量身定制的阈值可能为不同的人口群体提供更具可比性的筛查效益。
The fecal immunochemical test (FIT) is commonly used for colorectal cancer (CRC) screening. Despite demographic variations in stool hemoglobin concentrations, little data exist regarding optimal positivity thresholds by age and sex. Identify programmatic (multi-test) FIT performance characteristics and optimal FIT quantitative hemoglobin positivity thresholds in a large, population-based screening program. Retrospective cohort study Kaiser Permanente Northern and Southern California Adults 50–75 years of age, screening eligible, with baseline quantitative FIT results (2013–2014), and 2 years follow-up. Nearly two-thirds (411,641) had a previous FIT within 2 years. FIT programmatic sensitivity for CRC and number of positive tests per cancer detected, overall and by age and sex. Among 640,859 persons completing a baseline FIT and followed for 2 years, 481,817 (75%) had ≥1 additional FIT and 1,245 (0.19%) were diagnosed with CRC. Cancer detection (programmatic sensitivity) increased at lower positivity thresholds, from 925/1,245 (74.3%) at 30 μg/g, to 950 (76.3%) at 20 μg/g, and 987 (79.3%) at 10 μg/g; the number of positive tests per cancer detected increased from 43 at 30 μg/g, to 52 at 20 μg/g, and 85 at 10 μg/g. Reducing the positivity threshold from 20 to 15 μg/g would detect 3% more cancers and require 23% more colonoscopies. At the conventional 20 μg/g FIT threshold, programmatic sensitivity decreased with increasing age (79.0%, 73.4%, and 68.9% for ages 50–59, 60–69 and 70–75 years, respectively, p=0.009) and was higher in men than women (77.0% vs. 70.6%, p=0.011). Information on advanced adenoma were lacking. Increased cancer detection at lower positivity thresholds is counter-balanced by substantial increases in positive tests. Tailored thresholds may provide more comparable screening benefits for different demographic groups, dependent upon local resources.