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...     

亚太结直肠癌风险评分系统在我国北方无症状人群筛查中的应用北大核心CSCD

[目的]评价亚太结直肠癌筛查评分系统(APCS)在我国北方无症状人群筛查中的应用价值。[方法]采取整群抽样的方法,选取河南省40~74岁城市户籍无症状人群进行癌症危险因素调查和结肠镜检查,应用APCS计算每位研究对象患进展期肿瘤的危险分值,绘制受试者工作特征(ROC)曲线,并计算曲线下面积(AUC)和95%可信区间(95%CI),并采用Logistic回归分析计算不同危险分层中患结直肠进展期肿瘤的OR值及95%CI。[结果]共纳入无症状人群7 454例,接受结肠镜检查前评分,平均年龄(55.01±7.91)岁,进展期肿瘤检出率为1.50%。APCS分值范围为0~7分,预测的一致性好(P=0.886),区分能力一般(AUC为0.628,95%CI:0.579~0.678),但优于仅基于年龄变量的预测模型。以低风险组(0~1分)为对照组,中风险组(2~3分)和高风险组(4~7分)发生进展期肿瘤的风险分别为低风险组的1.97倍(95%CI:0.83~4.65)和4.07倍(95%CI:1.76~9.42)。[结论]基于年龄、性别、一级亲属结直肠癌家族史和吸烟构建的APCS是确定中国北方无症状人群进展期肿瘤风险的有用工具。     

2015—2019年广州市结直肠癌筛查不同初筛方式阳性人群肠镜结果分析

[目的]分析2015—2019年广东省广州市结直肠癌筛查的数据,比较不同初筛方式阳性人群肠镜结果,以期更好地动员居民参与肠镜检查。[方法]整理2015—2019年广州市结直肠癌筛查数据,将初筛阳性人群分为5组:仅高危因素问卷评估阳性(免疫化学法粪便隐血试验阴性)[high risk factor questionnaire (HRFQ) positive and fecal immunochemical test(FIT)negative,HRFQ+&Double-FIT-]、HRFQ阳性和1次FIT阳性(HRFQ+&Single-FIT+)、HRFQ阴性和1次FIT阳性(HRFQ-&Single-FIT+)、HRFQ阴性和2次FIT阳性(HRFQ-&DoubleFIT+)、HRFQ阳性和2次FIT阳性(HRFQ+&Double-FIT+)。采用多元Logistic回归比较不同初筛方式阳性人群肠镜结果。[结果]广州市共完成初筛403 585人,初筛阳性69 619人,初筛阳性率为17.25%,肠镜检查依从性为28.53%;HRFQ+&Double-FIT+、HRFQ-&DoubleFIT+、HRFQ-&Single-FIT+、HRFQ+&Single-FIT+组检出异常风险分别是HRFQ+&DoubleFIT-组的1.638、1.642、1.174和1.515倍,HRFQ-&Double-FIT+和HRFQ+&Single-FIT+组检出腺瘤风险分别是HRFQ+&Double-FIT-组的1.306和1.214倍,HRFQ+&Double-FIT+、HRFQ-&Double-FIT+、HRFQ-&Single-FIT+、HRFQ+&Single-FIT+检出进展性腺瘤风险分别是HRFQ+&Double-FIT-组的4.823、5.870、2.571和2.463倍,HRFQ+&Double-FIT+、HRFQ-&Double-FIT+、HRFQ-&Single-FIT+、HRFQ+&Single-FIT+检出肠癌风险分别是HRFQ+&Double-FIT-组的33.532、31.345、5.353和6.627倍。[结论]广州市结直肠癌筛查肠镜检查依从性较低,应加大对结直肠癌初筛阳性人群的动员,尤其是FIT 2次阳性的人群。     

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...     

2019—2020年湖南省城市居民结直肠癌筛查参与率、病变检出率及其影响因素分析

摘 要：［目的］ 分析湖南省城市癌症早诊早治项目中部分结直肠癌高危人群的结肠镜检查参与率和病变检出情况及其相关影响因素。［方法］ 基于2019—2020年湖南省城市癌症早诊早治项目,纳入部分符合研究要求的45~74岁受试者。所有受试者均接受流行病学问卷调查并进行癌症风险评估,推荐评估结果为结直肠癌高风险的人群在项目医院进行结肠镜检查。采用χ2检验比较一般人群和结直肠癌高危人群的特征差异;采用Logistic回归模型分析与结肠镜检查参与率相关的影响因素以及与结肠肿瘤检出率相关风险因素。［结果］ 22 893名筛查目标人群中,1 926名被判定为结直肠癌高风险,高风险率为8.4%。523名高风险人群按照研究要求接受了结肠镜检查,参与率为27.2%。多因素Logistic回归分析结果提示年龄、吸烟史、运动习惯和肠道疾病家族史是结肠镜检查参与率的影响因素。523名接受结肠镜检查的受试者中检出各类结直肠肿瘤142例（27.2%）。 多因素Logistic回归分析结果提示年龄和吸烟史是结直肠肿瘤检出率的影响因素,与45~49岁人群相比,60~64岁（OR=2.90,95%CI：1.25~7.22）以及65~69岁（OR=2.93,95%CI：1.24~7.43）人群结肠镜肿瘤检出率显著升高;与不吸烟人群相比,吸烟或已戒烟的人群（OR=1.90,95%CI：1.10~3.36）结肠镜肿瘤检出率更高。［结论］ 湖南省城市地区高危人群的结直肠癌筛查参与率仍处于较低水平,但在高危人群开展结肠镜筛查可检出较高比例的结直肠肿瘤,取得了较好的筛查效果。在未来的人群结直肠癌筛查项目中,对特定高风险群体开展健康宣教,提高其防癌健康素养和筛查参与率是亟待解决的关键问题。     

结直肠癌和癌前病变检出率与其危险因素关系

摘 要：［目的］ 探索结直肠癌各类危险因素与结直肠癌及其癌前病变检出率关系,为合理制定结直肠癌筛查策略与防控措施提供科学依据。［方法］ 基于海宁市2010～2012年40～74岁目标人群结直肠癌筛查信息,分析各类危险因素与结直肠癌及癌前病变检出率关系。［结果］危险因素量化评估问卷调查240 177人,筛查顺应率为88.25%,病史阳性率6.09%;两次大便隐血试验（FOBT）388 780份,阳性21 079份,阳性率5.42%,初筛确定高危人群33 624人,占筛查人数的13.85%;高危人群结肠镜检查24 046例,顺应率为76.01 %;共检出肠道病变（息肉、腺瘤、癌、溃疡）6552例（其中结直肠癌119例,进展期腺瘤1042例）,总检出率为27.25%。男性检出率明显高于女性(P<0.01);检出率随年龄增长而上升（趋势检验,P<0.01）,70岁年龄组的检出率比40岁组高出1倍左右。多因素非条件Logistic回归分析表明：年龄大(OR=1.103,95%CI：1.075～1.133,P=0.000),大便隐血试验（FOBT）阳性（OR=4.470 95%CI：2.129～9.385,P=0.000）,有慢性阑尾炎或手术史(OR=0.445,95%CI：0.199～0.996,P=0.049),结直肠息肉史（OR=0.225,95%CI：0.051～0.995,P=0.049）与结直肠癌检出率存在统计关联。［结论］ 应加强对有黏液血便、有慢性阑尾炎或手术史、结直肠息肉史、大便隐血试验阳性的老年男性的结直肠癌筛查。     

不同筛查方案结直肠癌筛查随机对照试验基线结果分析

摘 要：［目的］ 分析结肠镜、粪便隐血试验（FIT）及风险评估筛查方案的人群结直肠癌筛查参与率和筛查效果。［方法］ 2018年5月至2019年5月,在安徽省合肥市招募50～74岁且符合研究要求的受试者,将其随机分配到3个筛查组（按1∶2∶2的比例）：结肠镜组、FIT组、风险评估组。所有受试者进行风险调查和评估,结肠镜组进行结肠镜检查,FIT组进行FIT检测,阳性者行结肠镜检查,风险评估组评估为高危者进行结肠镜检查,低危者进行FIT检测。计算不同筛查方案的参与率、检出率和阳性预测值。［结果］ 共计招募3 821名受试者,结肠镜组、FIT组、风险评估组的参与率分别是45.3%（347/766）、96.0%（1 470/1 532）、86.0%(1 310/1 523);结肠镜检查参与率分析显示,FIT组阳性人群参与率最高为80.6%,结肠镜组最低为45.3%,差异有统计学意义（P＜0.05）;三组筛查方法在进展期肿瘤检出率方面,差异无统计学意义（P＞0.05）。FIT组阳性对于进展期腺瘤阳性预测值最高（P＜0.05）。在筛查中所需结肠镜检查负荷指标上,每检出1例进展期肿瘤所需要的结肠镜检查数,结肠镜组为20例,FIT组为10例,风险评估组为19例。［结论］ FIT组及风险评估组显示出较高的参与率,在人群筛查中所需结肠镜检查的负荷数量方面,FIT法展示了较好的筛查效率。     

粪便潜血试验和问卷调查在人群结直肠癌筛查中的应用评价

[目的]分析粪便潜血试验、危险因素数量化评估问卷调查在人群结直肠癌筛查中的应用价值。[方法]嘉善县2007年5月至2013年12月7个镇(街道)目标人群进行结直肠癌优化序贯筛查方案,即采用危险因素数量化评估问卷调查和粪便潜血试验作为初筛方案,完成结直肠癌筛查完成初筛117 130人,其中问卷调查116 153人,粪便潜血试验99 268人。通过初筛确定高危人群19 078人,最终有14 709人完成了结肠镜检查。[结果]在14 709人肠镜检查中,共检出结直肠癌148人,进展期腺瘤692人,非进展期腺瘤1590人。优化序贯筛查方案和粪便潜血试验对结直肠癌、进展期腺瘤和非进展期腺瘤的阳性预测值分别为1.01%、4.70%,10.81%和1.68%、6.22%和12.42%。问卷调查对结直肠癌、进展期腺瘤的阳性预测值明显低于优化序贯筛查方案,分别为0.50%、3.30%。如果筛查方案中去除慢性腹泻、慢性便秘、黏液便或血便史、不良生活事件史4个单项,对结直肠癌、进展期腺瘤、非进展期腺瘤的阳性预测值略有提高,能减少12.28%的肠镜检查量。[结论]我国现行的大肠癌优化序贯筛查方案对结直肠癌和进展期腺瘤有较高的阳性预测值,对非进展期腺瘤无明显效果,有进一步优化的必要和空间。     

2017—2021年北京市农村地区居民结直肠癌筛查结果及结肠镜检查依从性分析

[目的]分析2017—2021年北京市农村地区居民结直肠癌筛查结果及结肠镜检查依从性。[方法]采用整群抽样的方法选取北京市9个区的农村地区的40～74岁居民参与结直肠癌筛查。采用危险因素问卷调查和免疫法粪便潜血试验（FIT）进行初筛,对评估为高危的人群进行结肠镜检查。计算结直肠癌高危率、结肠镜检查的依从性及病变检出率。采用χ2检验比较不同特征居民对结肠镜检查依从性的差异和不同年龄段居民进展期腺瘤和癌与非进展期腺瘤检出率之间的差异。采用多因素Logistic回归模型分析结直肠癌高危人群结肠镜依从率的影响因素。[结果]共有153 791名居民完成结直肠癌危险因素问卷评估,评估出高危人群41 401人,高危率为26.9%。24 401人进行结肠镜检查,依从率为58.9%。多因素Logistic回归模型分析结果提示,与40～44岁的人群相比,60～64岁（OR=0.89,95%CI:0.80～0.98）、65～69岁（OR=0.74,95%CI:0.67～0.81）、70～74岁（OR=0.61,95%CI:0.54～0.69）的人群更不愿意接受结肠镜检查;与小学及以下文化程度者相比,中学文化...     

维吾尔族妇女型别特异性持续HPV感染状况及病毒学因素

目的:分析维吾尔族妇女型别特异性HPV持续感染的情况及转归。方法:以2012年9月至2013年9月在新疆自治区人民医院妇科门诊和病房自愿接受宫颈癌机会性筛查维吾尔族妇女为筛选对象,利用HC-ⅡHPV DNA检查和凯普HPV导流杂交分型技术确定HPV感染和型别,对筛查结果为HPV感染慢性宫颈 炎的妇女,通过问卷调查和36个月的随访,使用Logistic回归分析其持续感染影响因素。结果:HPV型别特异性持续感染率在12、24、36个月的复查时分别为25.5%(65/255),15.7%(40/255),11.0%(28/255);在随访12个月时HPV＞1 000段相对于病毒载量1≤HPV≤100妇女型别特异性持续感染的风险增加2.40倍(95%CI:1.11~5.15);随访24个月、36个月,发现单一型别比多重感染更容易发现型别特异性HPV持续感染(OR:3.07,95%CI:1.23~7.68;OR:4.31,95%CI:1.10~16.90);随访12个月、24个月、36个月,发现HPV16阳性比非HPV16型发生型别特异持续感染的风险增加(OR:4.81,95%CI:2.63~8.18;OR:2.73,95%CI:1.08~6.88;OR:4.69,95%CI:1.10~19.97)。结论:HPV16阳性、极高病毒载量、单一感染是维吾尔族妇女HPV持续感染的危险因素,应加强该人群的随访检测。     

The Optimal Cut-Off Level of The Fecal Immunochemical Test For Colorectal Cancer Screening in a Country with Limited Colonoscopy Resources: A Multi-Center Study from Thailand

Background: Selecting the cut-off point for the fecal immunochemical test (FIT) for colorectal cancer (CRC) screening programs is of prime importance. The balance between the test performance for detecting advanced neoplasia and the available colonoscopy resources should be considered. We aimed to identify the optimal cut-off of FIT for advanced neoplasia in order to minimize colonoscopy burden. Methods: We conducted a multi-center study in 6 hospitals from diverse regions of Thailand. Asymptomatic participants, aged 50-75 years, were tested with one-time quantitative FIT (OC-SENSOR, Eiken Chemical Co.,Ltd., Tokyo, Japan) and all participants underwent colonoscopy. We assessed test performance in detecting advanced neoplasia (advanced adenoma and CRC) and measured the burden of colonoscopy with different cut-offs [25 (FIT25), 50 (FIT50), 100 (FIT100), 150 (FIT150), and 200 (FIT200)ng/ml]. Results: Among 1,479 participants, advanced neoplasia and CRC were found in 137 (9.3%) and 14 (0.9%), respectively. From FIT25 to FIT200, the positivity rate decreased from 18% to 4.9%. For advanced neoplasia, an increased cut-off decreased sensitivity from 42.3% to 16.8% but increased specificity from 84.2% to 96.3%. The increased cut-off increased the positive predictive value (PPV) from 21.5% to 31.5%. However, all cut-off points provided a high negative predictive value (NPV) (>90%). For CRC, the miss rate for FIT25 to FIT 150 was the same (n=3, 21%), whereas that with FIT200 increased to 35% (n=5). Conclusions: In a country with limited-colonoscopy resources, using FIT150 may be preferred because it offers both high PPV and NPV for advanced neoplasia detection. It could also decrease colonoscopy workload, while maintaining a CRC miss rate similar to those with lower cut-offs.     

Optimizing the colorectal cancer screening programme using faecal immunochemical test (FIT) in Flanders,Belgium from the “interval cancer” perspective

Background Interval cancer (IC) is a critical issue in colorectal cancer (CRC) screening. We identified factors associated with ICs after faecal immunochemical test (FIT) screening and explored the impact of lowering FIT cut-off or shortening screening interval on FIT-ICs in Flanders.Methods FIT participants diagnosed with a CRC during 2013–2018 were included. Factors associated with FIT-ICs were identified using logistic regression. Distributions of FIT results among FIT-ICs were examined.Results In total, 10,122 screen-detected CRCs and 1534 FIT-ICs were included (FIT-IC proportion of 13%). FIT-ICs occurred more frequently in women (OR 1.58 [95% CI 1.41–1.76]) and ages 70–74 (OR 1.35 [1.14–1.59]). FIT-ICs were more often right-sided (OR 3.53 [2.98–4.20]), advanced stage (stage IV: OR 7.15 [5.76–8.88]), and high grade (poorly/undifferentiated: OR 2.57 [2.08–3.18]). The majority (83–92%) of FIT-ICs would still be missed if FIT cut-off was lowered from 15 to 10 µg Hb/g or screening interval was shortened from 2 to 1 year.Conclusions FIT-ICs were more common in women, older age, right-sided location, advanced stage and high grade. In Flanders, lowering FIT cut-off (to 10 µg Hb/g) or shortening screening interval (to 1 year) would have a minimal impact on FIT-ICs.Subject terms: Cancer screening, Risk factors, Colorectal cancer     

The second round of the Dutch colorectal cancer screening program: Impact of an increased fecal immunochemical test cut-off level on yield of screening

The Dutch colorectal cancer (CRC) screening program started in 2014, inviting the target population biennially to perform a fecal immunochemical test (FIT). We obtained prospectively collected data from the national screening information-system to present the results of the second round (2016) and evaluate the impact of increasing the FIT cut-off halfway through the first round from 15 to 47 μg Hb/g feces on outcomes in the second round. Second round screening was done with a 47 μg Hb/g feces FIT cut-off. Participants were classified based on first round participation status as either FIT (15,47) or FIT (47,47) participants, and previous nonparticipants. In total, 348,891 (75.9%) out of 459,740 invitees participated in the second round. Participation rates were 93.4% among previous participants and 21.0% among previous non-participants. FIT(47,47) participants had a significantly higher detection rate of AN (15.3 vs. 10.4 per 1,000 participants) compared to FIT(15,47) participants in the second round, while their cumulative detection rate of AN over two rounds was significantly lower (45.6 vs. 52.6 per 1,000 participants). Our results showed that participation in the Dutch CRC screening program was consistently high and that second round detection rates depended on the first round FIT cut-off. The cumulative detection over two rounds was higher among FIT(15,47) participants. These findings suggest that a substantial part of, but not all the missed findings in the first round due to the increased FIT cut-off were detected in the subsequent round.     

Seasonal variations do not affect the superiority of fecal immunochemical tests over guaiac tests for colorectal cancer screening

The aim of this study was to compare the seasonal variation in performance of a faecal immunochemical test for haemoglobin (FIT) and a guaiac test (gFOBT) for colorectal cancer screening. From June 2009 to May 2011, 18,290 screening participants (50–74 years old) performed OC‐SENSOR quantitative FIT (1 sample) and Hemoccult II gFOBT (3 stool samples with 2 spots/sample). Referral for colonoscopy required a minimum of one positive spot (gFOBT), or a positive FIT [cut‐off 150 ng haemoglobin/mL buffer (i.e. 30 μg haemoglobin/g feces)]. The performance of tests for detection of advanced neoplasia was compared according to seasons using Receiver Operating Characteristics (ROC) curves, at various FIT cut‐off values. The positivity rate of FIT was significantly lower in the summer compared with other seasons (2.3% versus 3.0%, p = 0.03), whilst the positivity rate of gFOBT increased in the autumn (1.8% versus 1.5%, p = 0.11). FIT was clinically more effective than gFOBT over the four season‐specific ROC curves. At the cut‐off concentration used in the study, the season‐specific FIT/gFOBT ratios for true positive rates were: 2.8 (Autumn), 2.5 (Winter), 3.0 (Spring), 3.7 (Summer), and for false positive rates: 1.2 (Autumn), 1.5 (Winter), 1.8 (Spring), 0.9 (Summer). Therefore, in this study with this cut‐off concentration and in spite of lower positivity rate in summer, the seasonal variations of performance of OC‐SENSOR FIT led to improved gain in specificity in the summer, without a decrease in gain in sensitivity compared with gFOBT.     

Factors associated with interval colorectal cancer after negative FIT: Results of two screening rounds in the Dutch FIT-based CRC screening program

The interval colorectal cancer (CRC) rate after negative fecal immunochemical testing (FIT) is an important quality indicator of CRC screening programs. We analyzed the outcomes of two rounds of the FIT-based CRC screening program in the Netherlands, using data from individuals who participated in FIT-screening from 2014 to 2017. Data of individuals with one prior negative FIT (first round) or two prior negative FITs (first and second round) were included. Outcomes included the incidence of interval CRC in FIT-negative participants (<47 μg Hb/g feces [μg/g]), FIT-sensitivity, and the probability of detecting an interval CRC by fecal hemoglobin concentration (f-Hb). FIT-sensitivity was estimated using the detection method and the proportional incidence method (based on expected CRC incidence). Logistic regression analysis was performed to estimate whether f-Hb affects probability of detecting interval CRC, adjusted for sex- and age-differences. Incidence of interval CRC was 10.4 per 10 000 participants after the first and 9.6 after the second screening round. FIT-sensitivity based on the detection method was 84.4% (95%CI 83.8-85.0) in the first and 73.5% (95% CI 71.8-75.2) in the second screening round. The proportional incidence method resulted in a FIT-sensitivity of 76.4% (95%CI 73.3-79.6) in the first and 79.1% (95%CI 73.7-85.3) in the second screening round. After one negative FIT, participants with f-Hb just below the cut-off (>40-46.9 μg/g) had a higher probability of detecting an interval CRC (OR 16.9; 95%CI: 14.0-20.4) than had participants with unmeasurable f-Hb (0-2.6 μg/g). After two screening rounds, the odds ratio for interval CRC was 12.0 (95%CI: 7.8-17.6) for participants with f-Hb just below the cut-off compared with participants with unmeasurable f-Hb. After both screening rounds, the Dutch CRC screening program had a low incidence of interval CRC and an associated high FIT-sensitivity. Our findings suggest there is a potential for further optimizing CRC screening programs with the use of risk-stratified CRC screening based on prior f-Hb.     

Uptake of faecal immunochemical test screening among nonparticipants in a flexible sigmoidoscopy screening programme

Screening programmes based on single modality testing may prevent individuals with a preference for a different test from participating. We conducted a population-based trial to determine whether nonparticipants in flexible sigmoidoscopy (FS) screening were willing to attend faecal immunochemical test (FIT) screening. In total, 8,407 subjects were invited in a primary FS screening programme. Invitees did not know at the time of FS invitation that nonparticipants would be offered FIT screening. A total of 4,407 nonparticipants of FS screening were invited for FIT screening (cut-off 50 ng haemoglobin/ml). The participation rate to FS screening was 31% [95% confidence interval (CI): 30-32%]. Among the FS nonparticipants 25% (CI: 24-26%) did attended FIT screening. The participation rate of the two-stage recruitment for FS and FIT screening was 45% (CI: 44-46%). FIT screenees were older (p = 0.02), more often women (p < 0.001) and had a lower social economic status (p = 0.01) than FS screenees. The detection rate (DR) for advanced adenoma was 3.5% (CI: 2.5-4.8%), and for colorectal cancer (CRC) it was 0.3% (CI: 0.1-0.8%) among participants to FIT screening. The DR of the two-stage recruitment was 6.1% (n = 202) for an advanced adenoma and 0.5% (n = 16) for a CRC. In conclusion, offering FIT screening to nonparticipants in a FS screening programme increases the overall participation rate considerably, as a quarter of nonparticipants of FS screening was willing to attend FIT screening. The participation rate remains lower for primary FIT screening in the same population (62%). Women in the target population were more likely to refuse FS than FIT screening. Countries introducing FS screening should be aware of these preferences.     

血清CEA与癌组织标本中TTF-1检测对肺腺癌EGFR突变的预测价值

目的:血清癌胚抗原(CEA)与癌组织标本中甲状腺转录因子-1(TTF-1)检测对肺腺癌表皮生长因子受体(EGFR)突变的预测价值。方法:选取2018年6月至2019年5月本院胸心外科住院部收治的92例经常规病理检查证实肺腺癌患者作为研究对象,根据突变特异性扩增系统(ARMS)聚合酶链反应(RT-PCR)方法检测EGFR突变结果分为EGFR突变组(n=55)和EGFR野生组(n=37),观察两组患者CEA、TTF-1表达情况,不同浓度CEA及与TTF-1联合对EGFR突变的预测价值。结果:EGFR突变组患者血清CEA水平、阳性率均明显高于EGFR野生组(P<0.05);EGFR突变组患者TTF-1阳性率为89.09%,高于EGFR野生组的13.51%(P<0.05);肺腺癌患者血清CEA水平≥5μg/L、≥20μg/L、≥50μg/L EGFR突变率高于<5μg/L患者(P<0.05),五组间EGFR突变率比较差异有统计学意义(P<0.05);血清CEA≥5μg/L对EGFR突变的敏感度、特异性较高;CEA≥5μg/L+TTF-1预测肺腺癌EGFR突变的敏感度、特异性、阳性预测值、阴性预测值、准确度最高。结论:肺腺癌EGFR突变患者血清CEA水平升高,TTF-1阳性率高,当CEA≥5μg/L且TTF-1阳性表达时对肺腺癌EGFR突变的预测率高。     

结直肠癌患者CD4+、CD8+T淋巴细胞介导免疫功能的影响因素

目的:探讨结直肠癌患者(colorectal cancer,CRC)CD4+、CD8+T淋巴细胞介导的细胞免疫功能与术前检查肿瘤标记物,患者术前基础疾病和一般情况之间的关系,研究发现影响CRC细胞免疫功能的高危因素。方法:收集2010年02月至2020年06月广西科技大学第二附属医院普通外科218例CRC患者完整的细胞免疫,肿瘤标志物,患者术前基础疾病和一般情况等资料,对数据进行统计描述,临床上界定各检验指标的正常值范围:细胞免疫CD4+和CD4+/CD8+的正常值分别为320~1 250个/μL和0.9~2.0;肿瘤标记物CEA,CA199,CA125,CA153,CA242,CA724的正常值范围分别为0~5 μg/L,0~37 μg/L,0~35 μg/L,0~31.3 μg/L,0~20 μg/L,0~5.7 μg/L。临床上常以患者外周血液检测中的CD4+T淋巴细胞计数或CD4+/CD8+比值低于正常值范围定义为患者的细胞免疫功能低下。对其进行回顾性研究分析,采用统计学SPSS 24.0统计软件,对计量资料用P-P图做正态性检验,对数据先进行单因素分析,有统计学意义的因素进入多因素二元Logistic回归分析的方法,研究发现结直肠癌患者CD4+、CD8+T淋巴细胞介导的细胞免疫功能与各临床参数之间的关系。结果:男性的CD4+水平低于女性,差异有统计学意义（P＜0.05）。血型对细胞免疫功能影响无统计学差异（P＞0.05）。CEA和CA199升高组CD4+水平均低于正常组,差异有统计学意义（P＜0.05）。年龄、T分期、术前心血管病分组、呼吸系统疾病分组的患者细胞免疫功能低下率差异无统计学意义（P＞0.05）。术前患有糖尿病患者细胞免疫功能低下率高于术前未患糖尿病患者,差异有统计学意义（P＜0.01）,术前有吸烟史患者细胞免疫功能低下率高于术前无吸烟史患者,差异有统计学意义（P＜0.01）。CRC细胞免疫功能影响因素的二元Logistic多因素回归分析:术前糖尿病史和术前有吸烟史是导致细胞免疫功能低下的危险因素(OR=5.372,95%CI:2.656~10.865,P＜0.001;OR=4.467,95%CI:2.105~9.476,P＜0.001）。结论:术前有糖尿病史和术前有吸烟史是影响CRC的CD4+、CD8+T淋巴细胞介导的细胞免疫功能低下的独立危险因素,其中术前有吸烟史最显著。患者的性别,术前检查肿瘤标记物CEA和CA199水平对判断CRC细胞免疫功能有一定的参考价值。     

Impact of time between faecal immunochemical tests in colorectal cancer screening on screening results: A natural experiment

Repeated rounds of faecal immunochemical testing (FIT) for occult blood is a common method for screening for colorectal cancer (CRC). However, the time interval between FIT rounds is not thoroughly investigated. In a CRC screening trial in South-Eastern Norway, individuals were invited for biennial FIT between 2012 and 2019. The positivity threshold was >15 mcg haemoglobin/g faeces (mcg/g). Due to organizational challenges, the interval between screening rounds randomly varied between 1.5 and 3.5 years, forming a natural experiment. We investigated the detection rate of CRC and advanced neoplasia (AN: CRC or advanced adenoma) at the subsequent round (FIT₂), according to the faecal haemoglobin concentration (f-Hb) at the initial screening round (FIT₁), and time between the two screening rounds. 18 522 individuals with negative FIT₁ who attended FIT₂ were included in this study. 245 AN were detected at FIT₂, of which 34 were CRC. The CRC detection rate at FIT₂ for participants with FIT₁ = 0 mcg/g was 0.09% while it was 0.28% for participant with 0 > FIT₁ ≤ 15 mcg/g; odds ratio (OR) 3.22, 95% CI 1.49-6.95. For each 3 months' increment between FITs, the OR for detecting CRC was 1.33 (95% CI 0.98-1.79), while the OR was 1.13 (1.02-1.26) for AN. Individuals with FIT₁-value of 0 mcg/g, had a lower AN detection rate compared with participants with 0 > FIT₁ ≤ 15 mcg/g, irrespective of time between tests. Although CRC and AN detection rates increase with increasing time interval between FITs, individuals with undetectable f-Hb at first screen have substantially lower risk of CRC at the next screening round compared with individuals with detectable f-Hb.     

Superior diagnostic performance of faecal immunochemical tests for haemoglobin in a head-to-head comparison with guaiac based faecal occult blood test among 2235 participants of screening colonoscopy

There is increasing evidence that faecal immunochemical tests (FITs) for haemoglobin offer a number of advantages over traditional guaiac based faecal occult blood tests (gFOBTs). However, evidence on diagnostic performance from direct comparisons with colonoscopy findings in all participants in the average risk population is still sparse. We aimed for a head-to-head comparison of three quantitative FITs with a gFOBT among participants of the German screening colonoscopy programme. Pre-colonoscopy stool samples and colonoscopy reports were obtained from 2235 participants of screening colonoscopy in 2005–2009. To enhance comparability of diagnostic performance of the various tests, we assessed sensitivity, specificity, predictive values and likelihood ratios of FITs after adjusting the FIT cut-off haemoglobin (Hb) concentrations in such a way that FIT positivity rates equalled the positivity rate of the gFOBT. Colorectal cancer, advanced adenomas and other adenomas were found in 15 (0.7%), 207 (9.3%) and 398 (17.8%) participants. The gFOBT was positive in 111 (5.0%) participants, with sensitivities (specificities) for detecting colorectal cancer, any advanced neoplasm or any neoplasm of 33.3% (95.2%), 8.6% (95.4%) and 5.5% (95.2%). At the same positivity rate, all three FITs outperformed the gFOBT in all indicators. In particular, all sensitivities of FITs were approximately two to three times higher at increased levels of specificity. All differences were statistically significant, except for some of the performance indicators for colorectal cancer. In conclusion, FITs can detect much larger proportions of colorectal neoplasms even if their cut-offs are set to levels that ensure equally low positivity rates as gFOBT.