摘要
目的:分析定量粪便免疫化学试验(fecal immunochemistry test,FIT)筛查阈值对体检人群结直肠肿瘤早筛价值的影响。方法:以2017年07月至2021年06月在我院接受定量FIT检测并行肠镜检查的1267例人群为研究对象,比较不同性质肿瘤的定量FIT数值和阳性率。通过Logistic回归和受试者工作特征(receiver operating characteristic,ROC)曲线分析比较不同性别、年龄和不同阳性阈值下定量FIT对进展期肿瘤的筛检效能。结果:定量FIT筛查阳性率为4.7%,阳性人群肠镜依从性为22.2%。结直肠癌患者的定量FIT数值高于进展期腺瘤和其他肠镜结果。当定量FIT水平为100~199μg/L、200~299μg/L、300~499μg/L和500μg/L以上时,患进展期肿瘤的风险分别是<100μg/L时的4.296倍、4.121倍、6.506倍和10.474倍。不同阳性阈值下,FIT阳性组进展期肿瘤检出率均高于阴性组,且在男性和50~75岁人群中均有统计学差异。在100μg/L时的比值比(odds ratio,OR)最大(总体OR=6.817,95%CI:2.727~17.040;男性OR=5.570,95%CI:2.198~14.115;50~75岁OR=10.178,95%CI:3.158~32.803)。此时,定量FIT对进展期肿瘤的灵敏度分别为94.7%、93.0%、96.2%,特异度分别为27.6%、29.6%、28.7%。当阳性阈值由100μg/L升高至500μg/L时,FIT诊断进展期肿瘤的灵敏度下降,特异度升高,但阳性预测值和阴性预测值变化不大。结论:定量FIT阳性阈值在100μg/L时筛查进展期结直肠肿瘤的灵敏度较好,但特异度较低,是应用在体检人群伺机性筛查中较好的结直肠肿瘤早筛参考指标。
Objective:To analyze the influence of screening threshold of quantitative fecal immunochemistry test(FIT)on the early screening value of colorectal tumor in physical examination population.Methods:A total of 1267 patients underwent quantitative FIT,colonoscopy and pathological examination in our hospital from July 2017 to June 2021 were selected as the subjects.The quantitative FIT values and positive rates of different types of tumors were compared.Logistic regression analysis and receiver operating characteristic(ROC)curve were used to compare the screening efficiency of quantitative FIT for advanced tumors in different gender,age groups and different positive critical values.Results:The positive rate of quantitative FIT was 4.7%.The colonoscopy compliance of positive patients was 22.2%.The quantitative FIT value of colorectal cancer patients was higher than advanced adenoma and other results.When quantitative FIT levels were 100~199μg/L,200~299μg/L,300~499μg/L and above 500μg/L,the risk of advanced tumors was 4.296 times,4.121 times,6.506 times and 10.474 times than<100μg/L,respectively.Under different positive critical values,the detection rate of advanced tumors in FIT positive group was higher than that in FIT negative group.The difference was statistically significant in males and 50~75 years old.When the positive cut-off value was 100μg/L,the odds ratio(OR)of advanced tumors detection rate in FIT positive group was the largest compared with negative group(total OR=6.817,95%CI:2.727~17.040.male OR=5.570,95%CI:2.198~14.115.50~75 years old OR=10.178,95%CI:3.158~32.803).The sensitivity of quantitative FIT for advanced tumors were 94.7%,93.0%and 96.2%,and the specificity was 27.6%,29.6%and 28.7%,respectively.When the positive cut-off value increased from 100μg/L to 500μg/L,the sensitivity of quantitative FIT for advanced tumor decreased and the specificity increased.But the positive predictive value and negative predictive value did not change much.Conclusion:Quantitative FIT has good sensitivity in the diagnosis of advanced colorectal tumor when the positive cut-off value was 100μg/L,but the specificity was low.It is a good reference index for early screening of colorectal tumor in opportunistic screening of physical examination population.
作者
杜俏俏
许娟
何春燕
殷国建
钱志远
陆朝晖
张文雅
DU Qiaoqiao;XU Juan;HE Chunyan;YIN Guojian;QIAN Zhiyuan;LU Zhaohui;ZHANG Wenya(Health Management Center,the Second Affiliated Hospital of Soochow University,Jiangsu Suzhou 215004,China;Clinical Laboratory,the Second Affiliated Hospital of Soochow University,Jiangsu Suzhou 215004,China;Department of Gastroenterology,the Second Affiliated Hospital of Soochow University,Jiangsu Suzhou 215004,China)
出处
《现代肿瘤医学》
CAS
北大核心
2023年第2期287-294,共8页
Journal of Modern Oncology
基金
江苏省苏州市科技发展计划项目(编号:SYS2020144)
江苏省苏州市“科教兴卫”青年科技项目(编号:KJXW2021014)
苏州大学附属第二医院青年职工预研基金项目(编号:SDFEYQN2027)。
关键词
粪便免疫化学试验
结直肠肿瘤
体检
阈值
fecal immunochemistry test(FIT)
colorectal tumor
physical examination
threshold
