结直肠癌机会性筛查的临床应用探讨

Clinical application of opportunistic screening for colorectal cancer

摘要:

目的 探讨结直肠癌机会性筛查（OS）的临床应用，旨在为进一步完善大肠癌筛查流程和提高筛查效率提供依据。方法 回顾性分析2019年1月－2020年12月该院3 398例结直肠癌OS阳性，并完成全结肠镜检查的患者的临床资料。完成高危因素问卷调查（HRFQ）和粪便免疫化学检测（FIT）后，建议对两种筛查方法中，任意一种结果呈阳性的患者，进行结肠镜检查。统计受检者的年龄、性别、病变检出情况和病变部位，根据初筛结果，比较不同筛查方法结直肠肿瘤检出率的情况。结果 3 398例受检者中，HRFQ（-）FIT（+）组进展期腺瘤和结直肠癌检出率高于HRFQ（+）FIT（-）组，差异均有统计学意义（P < 0.05）。在非进展期腺瘤检出率方面，HRFQ（-）FIT（+）组明显低于HRFQ（+）FIT（+）组，差异有统计学意义（P < 0.05）。FIT对结直肠肿瘤的敏感度总体上优于HRFQ，且FIT对远端结直肠肿瘤的敏感度高于近端，差异均有统计学意义（P < 0.05）。结论 HRFQ与FIT组合，比FIT或HRFQ单独使用，能筛选出更多的高危人群，从而检测出更多的结直肠肿瘤，通过及时的内镜下治疗或外科手术切除，可有效提高患者的5年生存率，降低人群的结直肠癌发病率和死亡率。

Abstract:

Objective To explore the clinical application of opportunistic screening (OS) for colorectal cancer in order to provide a basis for further improving the screening process and improving screening efficiency.Methods Clinical data of 3 398 patients with positive OS for colorectal cancer who completed total colonoscopy from January 2019 to December 2020 were retrospectively analyzed. After completion of the high risk factor questionnaire (HRFQ) and fecal immunochemical test (FIT), colonoscopy was recommended for patients who tested positive for either of the two screening methods. The age, sex, lesion detection and lesion location of the patients were counted, and the detection rate of colorectal tumors by different screening methods was compared according to the preliminary screening results.Results Among the 3 398 subjects, the detection rate of advanced adenoma and colorectal cancer in HRFQ (-) FIT (+) group were higher than that in HRFQ (+) FIT (-) group, there were significant differences between the two groups (P < 0.05). The detection rate of non-advanced adenoma in HRFQ (-) FIT (+) group was lower than that in HRFQ (+) FIT (+) group, there was significant difference between the two groups (P < 0.05). The sensitivity of FIT to colorectal tumors was generally better than that of HRFQ, and the sensitivity of FIT to distal colorectal tumors was higher than that of proximal colorectal tumors, there were significant differences between the two groups (P < 0.05).Conclusion The combination of HRFQ and FIT can screen more high-risk groups than FIT or HRFQ alone, thus detect more colorectal tumors, effectively improve the 5-year survival rate through timely endoscopic treatment or surgical resection, and ultimately reduce the morbidity and mortality of colorectal cancer in the population.