免疫胶体金便隐血试验在大肠癌普查中应用

[目的]探讨免疫胶体金便隐血试验在大肠癌筛查中的价值。[方法]对惠州市样本区常住全人口共50552人根据家族史、个人史和临床症状将其分为普通人群、高危人群和症状人群．先用免疫胶体金法便隐血试验进行初筛，再对隐血阳性者、高危人群和症状人群行结肠镜检查。[结果]实际调查人数33921人（应答率为67．10％），各组人群便隐血阳性率分别为：普通人群4．26％，高危人群11．26％，症状人群45．16％，三组人群之间差异有显著性（P〈0．001）；需内镜检查1920人，实际镜检1465人，共检出大肠癌4例，其中3例隐血试验阳性。[结论]免疫胶体金便隐血试验在大肠癌及大肠癌高发病风险人群的筛检方面有重要价值．但有一部分不出血的大肠癌会漏诊，因此最好结合肠镜等其它普查手段进行普查。     

定量免疫粪便隐血试验联合危险度评估在社区结直肠癌筛查中的应用

目的 探讨定量免疫粪便隐血试验（fecal immunochemical testing,FIT）联合危险度评估在社区结直肠癌（colorectal cancer,CRC）筛查中的应用价值。方法 选择2022年9月至2022年12月在吴江区开展CRC筛查的人群为研究对象。评估结果为阳性的有613例;评估阳性的人群中有320例作为试验组（1次定性FIT+1次定量FIT）,293例作为对照组（2次定性FIT）。试验组中有59例接受了肠镜检查,对照组中有36例接受了肠镜检查。结果 试验组的初筛阳性率为25.93%（83例）,对照组的初筛阳性率为18.77%（55例）,差异有统计学意义（P=0.034）。试验组接受肠镜检查的人群中,病变（CRC或结直肠腺瘤）的检出率为83.05%（49例）,对照组接受肠镜检查的人群中,病变（CRC或结直肠腺瘤）的检出率为63.89%（23例）,差异有统计学意义（P=0.032）。受试者操作特征曲线（receiver operator characteristic curve,ROC曲线）分析显示,定量FIT筛查早期肠道病变的曲线下面积为0.842（P=0.00...     

粪便隐血试验与SDC2基因甲基化检测在结直肠癌筛查中的效果评价

[目的]比较粪便SDC2基因甲基化检测与粪便隐血试验用于人群结直肠癌筛查效果,为今后开展结直肠癌筛查技术及方案优化提供科学依据。[方法]以海宁市结直肠癌早诊早治筛查为平台,于2021年5月采用整群抽样方法抽取海宁市袁花镇3 000名40～74岁人群为研究对象,将SDC2基因甲基化检测纳入现有筛查路径,初筛包括结直肠癌风险评估、粪便隐血试验和SDC2基因甲基化检测,其中任一项阳性动员电子结肠镜检查,以结肠镜+病理结果为金标准判定筛查结果。[结果]共有2 664名对象完成结直肠癌风险评估并按要求同时送检了两份大便样品,其中男性1 303名,女性1 361名。单项粪便SDC2基因甲基化阳性为232例(8.71%),阳性者中116例(50.00%)完成肠镜检查;单项粪便隐血试验阳性为243例(9.12%),阳性者中126例(51.85%)完成结肠镜检查;粪便隐血试验和SDC2基因甲基化检测双阳性51例(Kappa=0.077,P=0.614),双阳性者中28例(54.90%)完成结肠镜检查,三组差异无统计学意义(χ²=0.452, P=0.798)。在单阳性组中,粪便隐血...     

上海市社区居民大肠癌筛查便隐血检测效果分析

背景与目的：上海市为符合条件的居民提供免费的大肠癌筛查服务,通过对上海市居民大肠癌筛查中两次便隐血检测和后续诊断检查结果的分析,评价筛查中两次便隐血检测的效果,为基于人群的疾病筛查项目提供科学依据。方法：筛查的目标人群为50~74岁的上海居民,使用两次免疫法便隐血检测和危险度评估为初筛,初筛阳性者进行肠镜检查。结果：筛查期间,共有809 528人完成了两次便隐血检测,便隐血检测阳性者共有104 953人,其中第一次阳性的人数为47 421人,阳性率为5.9%,第二次阳性的人数为36 462人,阳性率为4.5%,两次阳性的人数为21 070人,阳性率为2.6%。便隐血检测阳性的筛查对象中,有49 339人接受了肠镜检查,肠镜检查顺应性为47.0%。两次阳性的筛查对象的肠镜参与率明显高于单次阳性的筛查对象（P<0.001）。在所有筛查出的大肠癌和癌前期病变中,仅进行一次便隐血检测可以诊断出大肠癌1 200例,占79.5%;发现癌前期病变3 777例,占68.1%。进行第二次便隐血检测可以多诊断出大肠癌310例,占20.5%;发现癌前期病变1 767例,占31.9%。结论：相比于单次便隐血检测, 进行两次便隐血检测的初筛可以更有效地检测出阳性对象,两次便隐血检测可提高后续肠镜检查的参与率,所检出的大肠癌和癌前期病变数量也均有所提高且增量成本较低。因此建议在以人群为基础的大肠癌筛查中采用两次或更多次数的便隐血检测,以提高筛查效率。     

隐血检测方法在肿瘤普查中的应用

由于恶性肿瘤起病隐袭,早期常缺乏特殊症状,一经发现往往已中晚期,所以肿瘤普查成为早发现、早诊断和早治疗肿瘤的重要手段。为此,采用医科院肿瘤所研制的隐血检测方法,对中国辐射防护研究院进行了一次肿瘤普查。痰隐血阳性者30例(7.21％)、胃液隐血阳性者13例(3.05％),经复查、胸透、上消化道造影及胃镜检查后,证实结果为假阳性。分析原因与炎症、出血有关。本方法简便、无痛苦、省钱,可做为肿瘤普查途径,并不断摸索经验。     

厦门市海沧区结直肠癌筛查结果分析

目的通过分析厦门市海沧区结直肠癌的筛查结果,探索筛查的结直肠癌最佳方案,以期达到对结直肠肿瘤的早发现、早诊断和早治疗。方法 自2008年12月—2010年10月,采用中国癌症基金会推荐的结直肠癌筛查方案,对海沧区4个行政村40~74岁常住居民结合问卷调查和连续粪便隐血试验(Fecal occult blood test,FOBT)进行初筛,共8179人,实际接受筛查6380人。高危人群接受全结肠镜检查。结果 经问卷调查和FOBT检测,获得结直肠癌高危人群1035例。81.06%的高危者接受全结肠镜检查,结直肠癌和腺瘤息肉及其他病变检出率分别为1.67%和23.96%。问卷调查及FOBT均阳性者结直肠癌检出率显著高于单纯问卷调查阳性者或单纯FOBT阳性者(P＜0.05);FOBT两次阳性者结直肠癌检出率显著高于FOBT阴性和FOBT单次阳性检出率(P＜0.05)。FOBT检测阳性次数与结直肠癌检出率和腺瘤息肉及其他病变检出率呈线性关系(P＜0.05)。结论 调查问卷和连续粪便隐血试验筛查可明显缩小高危人群,大大降低筛查的工作量。     

隐血广谱筛查空腔脏器慢性炎症、癌前疾病和早期癌

摘 要：收集验证并总结腔道系统微量出血是慢性炎症长期不愈、早期癌变的病理基础,从而作为广谱筛查癌症手段。 经过40多年的临床研究和全国数十家医院发表的文章现场验证,已在230多个县市筛查1700多万人群,癌前病变数十万人,查出早中期癌上万例。所有空腔脏器都不应该有微量出血,有出血就是不正常,应严密观察。凡是阳性人群经过严密观察近期都能发现5%~10%有癌前病变,或1%~3%早期癌。     

2018—2019年浙江省兰溪市结直肠癌筛查不同方案筛查效果的比较

[目的]比较结肠镜、免疫粪便隐血检测法（fecal immunochemical test,FIT）、新型风险分级筛查方案在浙江省兰溪市人群中的筛查效果。[方法]收集2018年6月—2019年6月浙江省兰溪市50～74岁满足研究条件的居民基线资料,并将其按照1∶2∶2比例随机分配至结肠镜组、FIT组、新型风险分级筛查组。结肠镜组进行结肠镜检查;FIT组首先进行FIT检测,FIT阳性者接受结肠镜检查;新型风险分级筛查组根据风险评估结果开展筛查,其中被评估为高危者接受结肠镜筛查,而被评估为低危者接受FIT筛查。比较3组间的人群参与率、结直肠肿瘤检出率及每检出1例进展期肿瘤所需结肠镜数。[结果]兰溪市基线共招募2 700名受试者入组,纳入男性1 154名（43.4%）,50～59岁者1 225名（46.1%）。相比结肠镜组（60.0%）,FIT组（99.2%）和新型风险分级筛查组（92.0%）的人群参与率更高。相比结肠镜组（7.5%）,FIT组（3.4%）和新型风险分级筛查组（3.8%）的进展期肿瘤（结直肠癌+进展期腺瘤）检出率较低。结肠镜组、FIT组、新型风险分级筛查组每检出1例进展期肿瘤...     

浙江省重点人群结直肠癌筛查项目设计和实施方案

摘 要：［目的］ 结直肠癌位居浙江省恶性肿瘤发病第3位、死亡第4位,是威胁居民健康和生命的重大公共卫生问题。开展结直肠癌筛查,实现结直肠癌的早期发现、早期诊断和早期治疗是降低结直肠癌负担的有效手段。［方法］ 2020年浙江省将重点人群结直肠癌筛查项目纳入省政府十方面民生实事,在全省范围内向50~74周岁户籍居民提供免费结直肠癌筛查服务。本文将重点阐述该项目的设计蓝图和实施方案。［结果］ 项目充分考虑浙江省结直肠癌疾病负担和公共卫生资源状况,结合浙江省结直肠癌筛查经验和工作基础,制定了筛查策略。 ［结论］ 浙江省重点人群结直肠癌筛查项目为积极探索适合中国国情的结直肠癌筛查策略提供理论依据和实践基础。     

结直肠癌免疫检查点治疗的研究进展

目前免疫治疗正在非小细胞肺癌、黑色素瘤、膀胱癌等各个瘤种中如火如荼地开展,其治疗方法也多种多样,包括肿瘤疫苗治疗、过继性T细胞疗法、免疫检查点抑制剂治疗等,但目前结直肠癌免疫治疗主要集中于免疫检查点抑制剂(PD-1/PD-L1及CTLA-4抑制剂等).自从PD-1/PD-L1抑制剂在dMMR/MSI-H晚期结直肠癌患者...     

Screening for Colorectal Cancer by Immunochemical Fecal Occult Blood Testing

Screening for colorectal cancer using the conventional Hemoccult test has been shown to reduce mortality associated with cancer by 33% through a randomized controlled trial. However, the magnitude of effectiveness is small in terms of cost-effectiveness. The recently developed immunochemical fecal occult blood test (IFOBT) provides a potential replacement for the Hemoccult test as a screening test, due to its superior performance characteristics such as higher sensitivity shown in preliminary studies and the fact that it does not require any dietary restriction. The IFOBT method is reviewed, especially in relation to its specificity. In known colorectal cancer subjects, IFOBTs have shown both higher sensitivity and specificity than the Hemoccult test. Similarly, IFOBT has demonstrated a higher sensitivity than Hemoccult for colorectal cancer in an asymptomatic population. A nationwide screening program in Japan has demonstrated the feasibility of this approach for large population screening. However, the positivity rate varied according to the conditions at each screening facility. Therefore, technical factors that influence the positivity rate of IFOBTs in the screening program are discussed. Case-control studies have strongly suggested that screening using IFOBT would reduce mortality from colorectal cancer by 60% or more. Several observational studies have provided support for this estimate. The feasibility and effectiveness of population-based screening by IFOBT are discussed.     

An Evaluation of Mass Screening Using Fecal Occult Blood Test for Colorectal Cancer in Japan: A Case-Control Study

There is as yet no firm evidence showing that mass screening for colorectal cancer using fecal occult blood tests (FOBTs) reduces the mortality from this cancer. Therefore we evaluated the effectiveness of the screening by a case-control study in Miyagi Prefecture, Japan. The study included as case subjects 28 individuals who had died from colorectal cancer and had had an opportunity to participate in the mass screening before the date of diagnosis as colorectal cancer, and 3 controls for each case subject randomly selected from residents who were alive on the date of death of case subjects and matched by sex, age (within 3 years) and living area using residential files. For each set, i.e., a case subject and 3 controls, screening histories before the date of the diagnosis of the case as colorectal cancer were examined. Both the case subjects and the controls who had participated in the screening at least once within 3 years before the date of diagnosis of the case were classified as "screened." The 28 case subjects consisted of 12 males and 16 females (average age: 60.8 years). The odds ratio of death from colorectal cancer for the screened versus the non-screened persons was 0.24 (95% confidence interval = 0.08–0.76) by the Mantel-Haenszel method. The present study suggests that mass screening using FOBTs for colorectal cancer significantly reduces the mortality from this cancer epidemiologically.     

Colorectal Cancer Screening: Yield of Faecal Occult Blood Testing

The incidence of colorectal cancer is rising and increasing public awareness of this condition has stimulatedinterest in screening tests. Colorectal cancer is treatable and curable in its early stages and clear benefits arepresent if the cancer can be detected in its early stages. Sensitivity of the faecal occult blood test (FOBT) byimmunochemical techniques for colorectal (CRC) cancer screening has been reported as 67% to 89% in certainpopulation screening programs. Although much work has been done to address screening of colorectal cancer inthe community, not much has been done to establish what the expected outcomes of screening are in a cohort ofvoluntary asymptomatic individuals. This paper retrospectively reviews the findings in such a cohort whosought health assessment (including a FOBT) at a Health Screening Centre in a tertiary hospital in Singaporeover the period of 2002 to 2007. The outcomes are discussed together with references to other relevant studies onfaecal occult blood test screening of CRC.     

Accuracy of Self-Checked Fecal Occult Blood Testing for Colorectal Cancer in Thai Patients

Purpose: Colorectal cancer (CRC) screening with fecal occult blood testing (FOBT) has been associatedwith a reduction in CRC incidence and CRC-related mortality. However, a conventional FOBT requires stoolcollection and handling, which may be inconvenient for participants. The EZ-DetectTM (Siam PharmaceuticalThailand) is a FDA-approved chromogen-substrate based FOBT which is basically a self-checked FOBT (nostool handling required). This study aimed to evaluate the accuracy of EZ-Detect for CRC detection. Methods:This prospective study was conducted in the Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand betweenNovember 2013 and May 2014. Some 96 patients with histologically-proven CRC and 101 patients with normalcolonoscopic findings were invited to perform self-checked FOBT according to the manufacturer’s instructions.Results were compared with endoscopic and pathologic findings. Sensitivity, specificity, positive predictive value(PPV), and negative predictive value (NPV) for CRC detection were calculated. Results: The present studyrevealed the sensitivity, specificity, PPV and NPV of this self-checked FOBT for CRC detection to be 41% (95%CI: 31-51), 97% (95% CI: 92-99), 93% (95% CI: 81-98) and 63% (95% CI: 55-70), respectively. The overallaccuracy of the self-checked FOBT for identifying CRC was 70%. The sensitivity for CRC detection based on7th AJCC staging was 29% for stage I, 32% for stage II and 50% for stage III/IV (P=0.19). The sensitivity was33% for proximal colon and 42% for distal colon and rectal cancer (P=0.76). Notably, none of nine infiltrativelesions gave a positive FOBT. Conclusions: The self-checked FOBT had an acceptable accuracy of CRC detectionexcept for infiltrative tumors. This home-administrated or ‘DIY’ do-it-yourself FOBT could be considered asone non-invasive and convenient tool for CRC screening.     

浙江省永康市大肠癌机会性筛查结果分析

[目的]了解机会性筛查在永康市大肠癌防治中的可行性.[方法]采用问卷调查及粪便隐血试验(FOBT)对40～74岁人群进行初筛,确定高危人群后,进行结直肠镜精筛,分析筛查对象的依从性、大肠的病变情况和大肠癌的早诊早治情况.[结果] 36 679人完成了初筛,其中FOBT的依从率为51.10％;评估高危人群5941人,进行肠镜检查5431人,检出各种大肠病变患者1006例,其中大肠癌患者163例,早期大肠癌患者54例,大肠癌的早诊率为59.48％,各种大肠病变的治疗率为98.51％.[结论]机会性筛查适合于永康市大肠癌的筛查,可检出更多大肠癌,特别是早期大肠癌及癌前病变.     

Colorectal Cancer Screening among Government Servants in Brunei Darussalam

Background: This study concerns uptake and results of colorectal cancer (CRC) screening of governmentservant as part of the Health Screening Program that was conducted in Brunei Darussalam in 2009. Materialsand Methods: Government servants above the age of 40 or with family history of CRC were screened with a singlefecal occult blood test (FIT, immunohistochemistry). Among 11,576 eligible subjects, 7,360 (66.9%) returned theirspecimen. Subjects with positive family history of CRC (n=329) or polyps (n=135) were advised to attend clinicsto arrange screening. All the subjects with positive FIT (n=142, 1.9%) were referred to the endoscopy unit forcounselling for screening colonoscopy. Results: Overall only 17.7% of eligible subjects attended for screening;54.9% (n=79/142) of positive FIT, 8.8% (n=29/329) of positive family history of CRC and none with history ofpolyps (n=0/135). Of these, only 54 patients (50.5%) agreed for colonoscopy, 52 (48.6%) declined as they wereasymptomatic, and one was not offered (0.9%) due to his very young age. On screening colonoscopy, 12.9% (n=7)had advanced lesions including a sigmoid carcinoma in situ and six advanced polyps. The other findings includednon advanced polyps (n=21), diverticular (n=11) and hemorrhoids (n=26). One patient who missed his screeningcolonoscopy appointment re-presented two years later and was diagnosed with advanced right sided CRC. Allthe advanced lesions were detected in patients with positive FIT, giving a yield of 20.5% for advanced lesionsincluding cancers in the 5.1% FIT positive subjects. Conclusions: Our study showed screening for CRC evenwith a single FIT was effective. However, the uptake rate was poor with just over half of the patients agreeing toscreening colonoscopy. Measures to increase public awareness are important. Since one limitation of our studywas the relatively small sample size, larger studies should be conduced in future.     

Toward standardizing and reporting colorectal cancer screening indicators on an international level: The International Colorectal Cancer Screening Network

The International Colorectal Cancer Screening Network was established in 2003 to promote best practice in the delivery of organized colorectal cancer screening programs. To facilitate evaluation of such programs, we defined a set of universally applicable colorectal cancer screening measures and indicators. To test the feasibility of data collection, we requested data on these variables and basic program characteristics from 26 organized full programs and 9 pilot programs in 24 countries. The size of the target population for each program varied considerably from a few thousand to 36 million. The majority of programs used fecal occult blood tests for primary screening, with more using guaiac than immunochemical tests. There was wide variation in the ability of screening programs to report the requested measures and in the values reported. In general, pilot programs were more likely to provide screening measure values than were full programs. As expected, detection rates for polyps and neoplasia were substantially higher in programs screening with endoscopy than in those using fecal occult blood tests. It is hoped that the screening measures and indicators, once revised in the light of this survey, will be adopted and used by existing programs and those in the early planning stages, allowing international comparison with the goal of improved colorectal cancer screening quality.