Positive Predictive Value for Multitarget Stool DNA After Bariatric and Metabolic Surgery.
Positive Predictive Value for Multitarget Stool DNA After Bariatric and Metabolic Surgery.
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DOI：
10.1016/j.gastha.2023.06.005
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Kisiel, John B
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作者：
Ebner, Derek W;Burger, Kelli N;Broderick, Brendan;Mahoney, Douglas W;Kellogg, Todd A;Acosta, Andres;Kisiel, John B
减肥和代谢手术（BMS）可能通过多种机制对结直肠癌（CRC）筛查的无创粪便检测产生不利影响。多靶点粪便DNA（mt-sDNA）被批准用于CRC筛查；然而，BMS 治疗后患者的表现尚不清楚。由于预计 BMS 率会随着肥胖发生率的上升而增加，因此评估这些患者的 mt-sDNA 测试表现非常重要。在多地点学术和社区实践中，我们通过电子记录和机构 BMS 注册表获得了 2014 年 10 月至 2019 年 12 月的 mt-sDNA 结果。在 mt-sDNA 呈阳性之前接受 BMS 的平均 CRC 风险患者接受了详细的图表审查。将后续结肠镜检查结果与仅使用结肠镜检查筛查的 BMS 患者和通过 mt-sDNA 筛查的未使用 BMS 的历史队列患者的结果进行比较。主要研究终点是晚期结直肠肿瘤的阳性预测值（PPV）。在 BMS 后进行 mt-sDNA 检测的 336 名平均风险患者中，49 例（14.6%）mt-sDNA 呈阳性，其中 47/49（96%）接受了随访结肠镜检查，晚期肿瘤的 PPV 为 12/47（25.5%）。这与在我们中心通过 mt-sDNA 筛查的历史队列中未接受过 BMS 的晚期结直肠肿瘤患者的 PPV 相似（425/1542，28%）（P = .86）。在既往接受过 BMS 的患者中，与仅筛查结肠镜检查相比，接受 mt-sDNA 治疗后晚期肿瘤发生率更高。尽管解剖学和生理学机制可能会改变粪便中的血液或 DNA 含量，但 BMS 似乎不会对 mt-sDNA 的 PPV 产生不利影响。
Bariatric and metabolic surgery (BMS) may adversely affect noninvasive stool tests for colorectal cancer (CRC) screening through several mechanisms. Multitarget stool DNA (mt-sDNA) is approved for CRC screening; however, performance in post-BMS patients is unknown. As the rates of BMS are anticipated to increase with rising incidence of obesity, it is important to evaluate mt-sDNA test performance among these patients. In a multisite academic and community-based practice, we obtained mt-sDNA results from 10/2014 to 12/2019 through electronic records and an institutional BMS registry. Average CRC risk patients with BMS prior to a positive mt-sDNA underwent a detailed chart review. Follow-up colonoscopy findings were compared to those among BMS patients screened with colonoscopy alone and a historical cohort of patients without BMS, screened by mt-sDNA. The primary study endpoint was the positive predictive value (PPV) for advanced colorectal neoplasia. Among 336 average-risk patients who had mt-sDNA after BMS, mt-sDNA was positive in 49 (14.6%), 47/49 (96%) underwent follow-up colonoscopy, and the PPV for advanced neoplasia was 12/47 (25.5%). This is similar to the PPV for advanced colorectal neoplasia (425/1542, 28%) in a historical cohort of persons without prior BMS, screened by mt-sDNA at our center (P = .86). Among those who had prior BMS, the rate of advanced neoplasia was higher after mt-sDNA compared to screening colonoscopy alone. Despite anatomic and physiologic mechanisms that could alter blood or DNA content in stool, BMS does not appear to adversely affect the PPV of mt-sDNA.