Fecal hemoglobin (f-Hb) immunochemical fecal occult blood test or simple fecal immunochemical test (FIT) is a recommended simple test for colorectal cancer (CRC) screening. F-Hb concentration in feces is an established diagnostic marker for CRC. Individuals whose f-Hb concentration is higher than the predetermined value will be referred for further colonoscopy.
The aim of this study was to evaluate the prognostic significance of repeated f-Hb concentration detection in fit based CRC screening.
265881 participants who participated in the Dutch fit based screening program from 2014 to 2018 and completed three rounds of fit were included, and the results of the first and second rounds were required to be negative (f-Hb <47 μ G hb/g feces). Interventions: the fit positive participants were followed up by colonoscopy.
Research process
Using the results of the third round of screening, the researchers evaluated the prognostic model used to detect advanced tumors (an) and CRC, using participants' age, gender, f-Hb in the first and second rounds and the class / combination / nonlinear transformation of f-Hb as predictors. The main evaluation criteria include: the accuracy of risk prediction (calibration), the distinguishing power of participants with or without an or CRC, the degree of risk stratification in external verification and C statistics.
Participant characteristics and findings
Among all study participants, 8806 (3.3%) were fit positive; 3254 patients (1.2%) were examined for advanced tumors, of which 557 (0.2%) were diagnosed with cancer. F-Hb concentration in the first and second rounds was the strongest predictor of outcome, with an adjusted odds ratio (or) of 9.4 (95% CI 7.5-11.7) for the highest f-Hb category. The risk prediction was matched with the risk observed by most participants, and the C statistics for distinguishing participants with and without an or CRC were 0.78 (95% CI 0.77-0.79) and 0.73 (95% CI 0.71-0.75), respectively.
Relative forecast risk of an and CRC
Participants' an predicted risk is 0.4%-36.7% and CRC predicted risk is 0.0%-5.5%. In external validation, the model maintained similar discrimination accuracy for an (C statistic 0.77, 95% CI 0.66-0.87) and CRC (0.78, 0.66-0.91).
In conclusion, this prognostic model can accurately identify the risk of future an or CRC according to age, sex, especially the previous f-Hb concentration.
Original source:
Meester RGS, van de Schootbrugge-Vandermeer HJ, Breekveldt ECH, et al Faecal occult blood loss accurately predicts future detection of colorectal cancer. A prognostic model Gut Published Online First: 10 May 2022. doi: 10.1136/gutjnl-2022-327188
Article source:
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