FIT-based risk-stratification model effectively screens colorectal neoplasia and early-onset colorectal cancer in Chinese population: a nationwide multicenter prospective study

作者：Shengbing Zhao, Shuling Wang, Peng Pan, Tian Xia, Rundong Wang, Quan-cai Cai, Xin Chang, Fan Yang, Lun Gu, Zixuan He, Jiayi Wu, Qianqian Meng, Tongchang Wang, Qiwen Fang, Xiaomei Mou, Honggang Yu, Jinghua Zheng, Cheng Bai, Yingbin Zou, Dongfeng Chen, Xiaoping Zou, Xu Ren, Leiming Xu, Ping Yao, Guangsu Xiong, Shu Xu, Tong Dang, Li Zhang, Wen Wang, Shengchao Kang, Hongfei Cao, Aixia Gong, Jun Li, Heng Zhang, Yiqi Du, Zhaoshen Li, Yu Bai, Gastrointestinal Early Cancer Prevention & Treatment Alliance of China (GECA) · 发表于：Journal of Hematology & Oncology · 年份：2022 · DOI：10.1186/s13045-022-01378-1 · 被引用次数：29 · 研究领域：Colorectal Cancer Screening and Detection、Gastric Cancer Management and Outcomes、Genetic factors in colorectal cancer

No fully validated risk-stratification strategies have been established in China where colonoscopies resources are limited. We aimed to develop and validate a fecal immunochemical test (FIT)-based risk-stratification model for colorectal neoplasia (CN); 10,164 individuals were recruited from 175 centers nationwide and were randomly allocated to the derivation (n = 6776) or validation cohort (n = 3388). Multivariate logistic analyses were performed to develop the National Colorectal Polyp Care (NCPC) score, which formed the risk-stratification model along with FIT. The NCPC score was developed from eight independent predicting factors and divided into three levels: low risk (LR 0-14), intermediate risk (IR 15-17), and high risk (HR 18-28). Individuals with IR or HR of NCPC score or FIT+ were classified as increased-risk individuals in the risk-stratification model and were recommended for colonoscopy. The IR/HR of NCPC score showed a higher prevalence of CNs (21.8%/32.8% vs. 11.0%, P < 0.001) and ACNs (4.3%/9.2% vs. 2.0%, P < 0.001) than LR, which was also confirmed in the validation cohort. Similar relative risks and predictive performances were demonstrated between non-specific gastrointestinal symptoms (NSGS) and asymptomatic cohort. The risk-stratification model identified 73.5% CN, 82.6% ACN, and 93.6% CRC when guiding 52.7% individuals to receive colonoscopy and identified 55.8% early-onset ACNs and 72.7% early-onset CRCs with only 25.6% young individuals receiving colon...