[Comparison of application effects of colonoscopy, fecal immunochemical test and a novel risk-adapted screening approach in colorectal cancer screening in Xuzhou population].

Objective: To compare the application effect of the colonoscopy, fecal immunochemical test (FIT) and novel risk-adapted screening approach in colorectal cancer screening in Xuzhou population. Methods: From May 2018 to April 2019, 4 280 subjects aged 50-74 were recruited from Gulou district, Yunlong district and Quanshan district of Xuzhou. They were randomly assigned to the colonoscopy group (n=863), FIT group (n=1 723) and novel risk-adapted screening approach group (n=1 694) according to the ratio of 1∶2∶2. For the novel risk-adapted screening approach group, after the risk assessment, high-risk subjects were invited to undergo colonoscopy and low-risk subjects were invited to undergo FIT examination. All FIT positive subjects were invited to undergo colonoscopy. Colonoscopy participation rate [(the number of colonoscopies completed/the number of colonoscopies invited to participate)×100%], detection rate of colorectal lesions [(the number of diagnosed patients/the number of colonoscopies completed)×100%], colonoscopy resource load (the number of colonoscopies completed/the number of diagnosed advanced tumors) and FIT resource load in each group were calculated and compared. Results: The age of all subjects was (61±6) years old, including 1 816 males (42.43%). There was no statistically significant difference in the socio-demographic characteristics of the subjects in different screening groups. The colonoscopy participation rate was 22.60% (195/863) in the colonoscopy group, 57.04% (77/135) in the FIT group, and 33.94% (149/439) in the novel risk-adapted screening approach group, respectively. The colonoscopy participation rate was higher in the FIT group than in the colonoscopy group and the novel risk-adapted screening approach group (P<0.001). The colonoscopy participation rate of novel risk-adapted screening group was significantly higher than the colonoscopy group (P<0.001). The detection rates of advanced tumors were 6.67% (13/195), 9.09% (7/77) and 8.72% (13/149), respectively, and the difference was not statistically significant (P>0.05). The colonoscopy resource load (95%CI) was 15 (13-17) in the colonoscopy group, 11 (9-14) in the FIT group and 11 (10-13) in the novel risk-adapted screening approach group, respectively. Among them, the colonoscopy resource load of high-risk individuals in the novel risk-adapted screening approach group was 12 (9-15). FIT resource loads (95%CI) were 207 (196-218) and 88 (83-94) in the FIT group and the novel risk-adapted screening approach group. Conclusion: The combined application of risk-adapted screening approach and FIT may have a good application effect in colorectal cancer screening.目的： 比较结肠镜、免疫法粪便隐血实验（FIT）和新型风险评估筛查方案在徐州市人群结直肠癌（CRC）筛查中的应用效果。 方法： 2018年5月至2019年4月于徐州市鼓楼区、云龙区、泉山区招募4 280名50~74岁对象，按1∶2∶2比例随机分配为结肠镜组（863名）、FIT组（1 723名）和新型风险评估筛查方案组（1 694名）。新型风险评估筛查方案组经过风险评估后高风险者邀请接受结肠镜检查，低风险者邀请接受FIT检查，所有FIT阳性者均邀请进行结肠镜检查。计算并比较各组结肠镜参与率［（完成结肠镜人数/邀请参与结肠镜人数）×100%］、结直肠病变检出率［（确诊人数/完成结肠镜人数）×100%］、结肠镜资源负载（完成结肠镜检查人数/确诊进展期肿瘤人数）和FIT资源负载。 结果： 4 280名对象年龄为（61±6）岁，其中男性1 816名（42.43%），不同筛查方案组对象的社会人口学特征差异无统计学意义。结肠镜组、FIT组、新型风险评估筛查方案组的结肠镜参与率分别为22.60%（195/863）、57.04%（77/135）、33.94%（149/439），FIT组高于结肠镜组和新型风险评估筛查方案组，新型风险评估筛查方案组高于结肠镜组（均P<0.001）；进展期肿瘤检出率分别为6.67%（13/195）、9.09%（7/77）、8.72%（13/149），差异无统计学意义（P>0.05）。结肠镜组、FIT组、新型风险评估筛查方案组结肠镜资源负载（95%CI）分别为15（13~17）、11（9~14）和11（10~13）名，其中新型风险评估筛查方案组中高风险个体结肠镜资源负载为12（9~15）名。FIT组和新型风险评估筛查方案组FIT资源负载（95%CI）分别为207（196~218）和88（83~94）名。 结论： 风险评估模型与FIT的综合应用在结直肠癌筛查中可能有一定效果。.