创作:szx 审核:szx 02月22日
  • 纳入2004-2009年间的5,417,699名接受FIT筛查的台湾受试者,随访至2014年;
  • FIT筛查显著降低了进展期结直肠癌发病率(48.4/10万人 vs. 75.7/10万人,校正后RR=0.66)及结直肠癌死亡率(20.3/10万人 vs. 41.3/10万人,校正后RR=0.60);
  • 相比于近端进展期结直肠癌发病率及近端结直肠癌死亡率(校正后RR分别为0.84及0.72),FIT筛查对降低远端进展期结直肠癌发病率及远端结直肠癌死亡率更为有效(校正后RR分别为0.61及0.56)。
Gut [IF:19.819]

Long-term effectiveness of faecal immunochemical test screening for proximal and distal colorectal cancers



01-25, Article

Abstract & Authors:展开

Objective: To measure the effects of faecal immunochemical test (FIT) for colorectal cancer (CRC) screening on overall and site-specific long-term effectiveness of population-based organised service screening.
Design : A prospective cohort study of Taiwanese nationwide biennial FIT screening was performed. A total of 5 417 699 eligible subjects were invited to attend screening from 2004 through 2009 and were followed up until 2014. We estimated the adjusted relative rates (aRRs) on the effectiveness of reducing advanced-stage CRC (stage II+) and CRC death by Bayesian Poisson regression models with the full adjustment for a cascade of self-selection factors (including the screening rate and the colonoscopy rate) and the completeness of colonoscopy together with demographic features.
Results: FIT screening (exposed vs unexposed) reduced the incidence of advanced-stage CRC (48.4 vs 75.7 per 100 000) and mortality (20.3 vs 41.3 per 100 000). Statistically significant reductions of both incidence of advanced-stage CRCs (aRR=0.66, 95% CI 0.63 to 0.70) and deaths from CRC (aRR=0.60, 95% CI 0.57 to 0.64) were noted. FIT screening was more effective in reducing distal advanced-stage CRCs (aRR=0.61, 95% CI 0.58 to 0.64) and CRC mortality (aRR=0.56, 95% CI 0.53 to 0.69) than proximal advanced CRCs (aRR=0.84, 95% CI 0.77 to 0.92) and CRC mortality (aRR=0.72, 95% CI 0.66 to 0.80).
Conclusion: A large-scale population-based biennial FIT screening demonstrates 34% significant reduction of advanced-stage CRCs and 40% reduction of death from CRC with larger long-term effectiveness in the distal colon than the proximal colon. Our findings provide a strong and consistent evidence-based policy for supporting a sustainable population-based FIT organised service screening worldwide. The disparity of site-specific long-term effectiveness also provides an insight into the remedy for lower effectiveness of FIT screening in the proximal colon.

First Authors:
Han-Mo Chiu

Correspondence Authors:
Tony Hsiu-Hsi Chen

All Authors:
Han-Mo Chiu,Grace Hsiao-Hsuan Jen,Ying-Wei Wang,Jean Ching-Yuan Fann,Chen-Yang Hsu,Ya-Chung Jeng,Amy Ming-Fang Yen,Sherry Yueh-Hsia Chiu,Sam Li-Sheng Chen,Wen-Feng Hsu,Yi-Chia Lee,Ming-Shiang Wu,Chien-Yuan Wu,Yann-Yuh Jou,Tony Hsiu-Hsi Chen