REDUCING MORTALITY FROM COLORECTAL-CANCER BY SCREENING FOR FECAL OCCULT BLOOD
REDUCING MORTALITY FROM COLORECTAL-CANCER BY SCREENING FOR FECAL OCCULT BLOOD
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DOI：
10.1056/nejm199305133281901
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发表时间：
1993-05-13
影响因子：
158.5
通讯作者：
EDERER, F
中科院分区：
文献类型：
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作者：
MANDEL, JS;BOND, JH;EDERER, F
背景。尽管粪便潜血检测广泛用于筛查结直肠癌，但没有确凿的证据表明它们可以降低结直肠癌的死亡率。我们在一项随机试验中评估了粪便潜血测试并记录了其有效性。方法。我们将 46,551 名 50 至 80 岁的参与者随机分配到每年一次的结直肠癌筛查组、每两年筛查一次或对照组。接受筛查的参与者提交了六张愈创木脂浸渍的纸片，其中连续三个粪便中的每一个都有两张涂片。大约 83% 的载玻片被再水化。测试呈阳性的参与者接受了包括结肠镜检查在内的诊断评估。经过 13 年的随访，确定了所有参与者的生命状况。一个委员会确定了死亡原因。一位病理学家确定了每个组织样本的癌症阶段。通过序贯对数秩统计来监测主要研究终点结直肠癌死亡率的差异。结果。每年筛查组中每 1000 人的 13 年累积结直肠癌死亡率为 5.88（95% 置信区间，4.61 至 7.15），每两年筛查组为 8.33（95% 置信区间，6.82 至 9.84），对照组为 8.83（95% 置信区间，7.26 至 10.40）。每年筛查组（而非每两年筛查组）的比率显着低于对照组。每年筛查组的死亡率降低，结直肠癌患者的生存率提高，并且转向癌症早期阶段的检测。结论。每年进行粪便潜血检测并对样本进行补水，使结直肠癌 13 年累积死亡率降低了 33%。
Background. Although tests for occult blood in the feces are widely used to screen for colorectal cancers, there is no conclusive evidence that they reduce mortality from this cause. We evaluated a fecal occult-blood test in a randomized trial and documented its effectiveness.Methods. We randomly assigned 46,551 participants 50 to 80 years of age to screening for colorectal cancer once a year, to screening every two years, or to a control group. Participants who were screened submitted six guaiac-impregnated paper slides with two smears from each of three consecutive stools. About 83 percent of the slides were rehydrated. Participants who tested positive underwent a diagnostic evaluation that included colonoscopy. Vital status was ascertained for all participants over 13 years of follow-up. A committee determined causes of death. A single pathologist determined the stage of cancer for each tissue specimen. Differences in mortality from colorectal cancer, the primary study end point, were monitored with the sequential log-rank statistic.Results. The 13-year cumulative mortality per 1000 from colorectal cancer was 5.88 in the annually screened group (95 percent confidence interval, 4.61 to 7.15), 8.33 in the biennially screened group (95 percent confidence interval, 6.82 to 9.84), and 8.83 in the control group (95 percent confidence interval, 7.26 to 10.40). The rate in the annually screened group, but not in the biennially screened group, was significantly lower than that in the control group. Reduced mortality in the annually screened group was accompanied by improved survival in those with colorectal cancer and a shift to detection at an earlier stage of cancer.Conclusions. Annual fecal occult-blood testing with rehydration of the samples decreased the 13-year cumulative mortality from colorectal cancer by 33 percent.