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亚太结直肠癌风险评分与粪便免疫化学检测在结直肠癌筛查的效果比较：基于山东省13个地区的横断面调查

Comparison of effectiveness of Asia-Pacific Colorectal Screening score and fecal immunochemical test in colorectal cancer screening: a cross-sectional study based on 13 regions in Shandong province

    摘要
  • 摘要:
    目的 评价亚太结直肠癌风险评分（APCS）问卷和粪便免疫化学检测（FIT）在人群结直肠癌筛查中单独及联合应用的效果，为结直肠癌精准防控与人群分层管理提供参考依据。
    方法 收集2024年山东省结直肠癌筛查项目数据，研究对象为在13个地区以社区为单位招募的6 259名 40～74岁、当地居住≥3 年的社区居民。以病理检查结果为金标准，比较单一使用APCS问卷、单一使用FIT（50 ng/mL）、单一使用FIT（100 ng/mL）、联合使用APCS问卷和FIT（50 ng/mL）、联合使用APCS问卷和FIT（100 ng/mL）、直接进行结肠镜检查6种筛查方法的进展期病变检出率以及结肠镜检查负荷。
    结果 单一使用APCS问卷、单一使用FIT（50 ng/mL）、单一使用FIT（100 ng/mL）、联合使用APCS问卷和FIT（50 ng/mL）、联合使用APCS问卷和FIT（100 ng/mL）、直接进行结肠镜检查6种筛查方法的进展期病变检出率分别为10.50%、46.15%、41.14%、57.98%、52.05%、7.35%，结直肠癌检出率分别为1.06%、10.38%、15.19%、15.97%、21.90%、0.72%，进展期腺瘤检出率分别为9.44%、35.77%、25.95%、42.02%、30.14%、6.63%；不同筛查方法进展期病变、结直肠癌和进展期腺瘤检出率差异均有统计学意义（均P<0.001），联合使用APCS问卷和FIT（50 ng/mL）方法对进展期病变和进展期腺瘤的检出率最高，联合使用APCS问卷和FIT（100 ng/mL）方法对结直肠癌的检出率最高。分层分析结果显示，单一使用FIT（50 ng/mL）方法对40～54岁社区居民进展期病变和进展期腺瘤的检出率最高，单一使用FIT（100 ng/mL）方法对40～54岁和55～64岁社区居民结直肠癌的检出率最高，联合使用APCS问卷和FIT（50 ng/mL）方法对男性、女性、55～64岁和65～74岁社区居民进展期病变和进展期腺瘤的检出率最高，联合使用APCS问卷和FIT（100 ng/mL）方法对男性、女性和65～74岁社区居民结直肠癌的检出率最高（均P<0.001）。以每检出1例病变所需结肠镜次数作为评价人群筛查时结肠镜检查负荷的指标，联合使用APCS问卷和FIT（50 ng/mL）方法每检出1例进展期病变和进展期腺瘤所需的结肠镜次数均最少，分别为1.72（95%CI=1.41～2.03）次和2.38（95%CI=1.95～2.81）次；联合使用APCS问卷和FIT（100 ng/mL）方法每检出1例结直肠癌所需的结肠镜次数最少，为4.56（95%CI=3.52～5.61）次。
    结论 在医疗资源有限的地区推荐采用APCS问卷和FIT联合方法以快速识别结直肠癌高风险人群，但在医疗资源和资金充足的地区则推荐直接进行结肠镜检查以获取更全面且精准的病变检出情况。

     

    Abstract:
    Objective To evaluate the effectiveness of the Asia-Pacific Colorectal Screening (APCS) questionnaire and the fecal immunochemical test (FIT), used alone and in combination,in population-based colorectal cancer screening, and to provide evidence for precision prevention and population stratification management of colorectal cancer.
    Methods Data were collected from the 2024 Shandong Province colorectal cancer screening program.The study population consisted of 6 259 community residents aged 40–74 years who had lived locally for at least 3 years, recruited from 13 regions using community-based sampling. With pathological examination results as the gold standard, the detection rate of advanced neoplasia and the colonoscopy workload were analyzed for six screening methods: APCS, FIT (50 ng/mL), FIT (100 ng/mL), APCS + FIT (50 ng/mL), APCS + FIT (100 ng/mL), and direct colonoscopy.
    Results  APCS, FIT (50 ng/mL), FIT (100 ng/mL), APCS + FIT (50 ng/mL), APCS + FIT (100 ng/mL), and direct colonoscopy showed the detection rates for advanced neoplasia being 10.50%, 46.15%, 41.14%, 57.98%, 52.05%, and 7.35%, the detection rates for colorectal cancer being 1.06%, 10.38%, 15.19%, 15.97%, 21.90%, and 0.72%, and the detection rates for advanced adenoma being 9.44%, 35.77%, 25.95%, 42.02%, 30.14%, and 6.63%, respectively. The detection rates for advanced neoplasia, colorectal cancer, and advanced adenoma differed among the screening methods (all P < 0.001). APCS + FIT (50 ng/mL) yielded the highest detection rates for both advanced neoplasia and advanced adenoma, while APCS + FIT (100 ng/mL) had the highest detection rate for colorectal cancer. Stratified analysis revealed that FIT (50 ng/mL) had the highest detection rates for advanced neoplasia and advanced adenoma in community residents aged 40–54 years. FIT (100 ng/mL) showed the highest detection rate for colorectal cancer among residents aged 40–54 and 55–64 years. APCS + FIT (50 ng/mL) achieved the highest detection rates for advanced neoplasia and advanced adenoma in males, females, and residents aged 55–64 and 65–74 years. APCS + FIT (100 ng/mL) yielded the highest detection rates for colorectal cancer in males, females, and residents aged 65–74 years (all P < 0.001). Using the number of colonoscopies required to detect one lesion as an indicator of colonoscopy workload in population screening. That APCS + FIT (50 ng/mL) required the fewest colonoscopies to detect one case of advanced neoplasia and one case of advanced adenoma, at 1.72 (95%CI: 1.41–2.03) and 2.38 (95%CI: 1.95–2.81), respectively. APCS + FIT (100 ng/mL) required the fewest colonoscopies to detect one case of colorectal cancer, at 4.56 (95%CI: 3.52–5.61).
    Conclusions In regions with limited medical resources, APCS + FIT is recommended to rapidly identify individuals at high risk of colorectal cancer. However, in regions with sufficient medical resources and funding, direct colonoscopy is recommended to achieve more comprehensive and precise lesion detection.

     

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