Fecal immunochemical test surveillance in colorectal cancer following adenoma resection: A longitudinal, population-based linked cohort study in China

作者：Jianhui Zhao, Chengcheng Liu, Jinhua Yang, Yanqin Huang, Liying Xu, Qian Xiao, Mingjuan Jin, Xiangxing Kong, Yeting Hu, Qilong Li, Suzhan Zhang, Xue Li, Shu Zheng, Kun Chen, Kefeng Ding · 发表于：PLoS Medicine · 年份：2025 · DOI：10.1371/journal.pmed.1004687 · 被引用次数：2 · 研究领域：Colorectal Cancer Screening and Detection、Diverticular Disease and Complications、Colorectal Cancer Surgical Treatments

BACKGROUND: Although the fecal immunochemical test (FIT) is widely utilized in colorectal cancer (CRC) screening because of its noninvasive, rapid, and cost-effective characteristics, its effectiveness in post-adenoma resection surveillance remains unclear. This study aims to evaluate the benefits of follow-up FIT surveillance in individuals with adenoma resection and to identify risk factors associated with adenoma recurrence. METHODS AND FINDINGS: As part of China's National Screening Project, we identified a total of 5,911 individuals who underwent adenoma removal during the first round of CRC screening in Jiashan and Haining between 2006 and 2021. All individuals with adenoma removal were invited to participate in a second CRC screening; 2,448 accepted and chose either direct colonoscopy surveillance (n = 989) or FIT surveillance (n = 1,459), while 3,463 declined. The Clone-Censor-Weight method was applied to mitigate time-related biases. Cox proportional hazards and Poisson regression models were used to evaluate the benefits of follow-up surveillance strategies after adenoma resection, adjusting for age, sex, baseline adenoma grade, family history of CRC in first-degree relatives, symptoms, chronic appendicitis or cholecystitis, and stressful life events. Additionally, we examined the risk factors associated with adenoma recurrence using logistic regression. The outcomes were the long-term incidence of CRC and the recurrence of adenomas following adenoma resection. Over...