Retrospective cohort study: Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy: Role of faecal immunochemical test
Pin-Vieito, N. ; Iglesias, M. J. ; Remedios, D. ; Rodríguez-Alonso, L. ; Rodriguez-Moranta, F. ; Álvarez-Sánchez, V. ; Fernández-Bañares, F. ; Boadas, J. ; Martínez-Bauer, E. ; Campo, R. ; Bujanda, L. ; Ferrandez, Á. (Universidad de Zaragoza) ; Piñol, V. ; Rodríguez-Alcalde, D. ; Guardiola, J. ; Cubiella, J. ; González-López, N. ; Quintero, E. ; Bañales, J. ; Bujanda, L. ; Perugorria, M. J. ; Cleries, R. ; Ribes, J. ; Sanz, X. ; López-Vicente, J. ; Rodriguez-Alcalde, D. ; Piñol, V. ; Torrealba, L. ; Blanco, I. ; Cubiella, J. ; Díaz-Ondina, M. ; Salve, M. ; Fernández-Seara, J. ; Iglesias, M. J. ; Macía, P. ; Remedios, D. ; Sánchez, E. ; Vega, P. ; Campo, R. ; Martínez-Bauer, E. ; Pujol, M. ; Sánchez, V. Á. ; Mera, J. ; Turnes, J. ; Clofent, J. ; Garayoa, A. ; Fernández-Bañares, F. ; Gonzalo, V. ; Pujals, M. ; Boadas, J. ; Galter, S. ; Garcia-Lanuza, E. ; Gimeno, R. ; Alsius, A. ; Ferrández, Á. ; Sánchez, M. S.
Resumen: BACKGROUND: Faecal immunochemical test (FIT) has been recommended to assess symptomatic patients for colorectal cancer (CRC) detection. Nevertheless, some conditions could theoretically favour blood originating in proximal areas of the gastrointestinal tract passing through the colon unmetabolized. A positive FIT result could be related to other gastrointestinal cancers (GIC).
AIM: To assess the risk of GIC detection and related death in FIT-positive symptomatic patients (threshold 10 µg Hb/g faeces) without CRC.
METHODS: Post hoc cohort analysis performed within two prospective diagnostic test studies evaluating the diagnostic accuracy of different FIT analytical systems for CRC and significant colonic lesion detection. Ambulatory patients with gastrointestinal symptoms referred consecutively for colonoscopy from primary and secondary healthcare, underwent a quantitative FIT before undergoing a complete colonoscopy. Patients without CRC were divided into two groups (positive and negative FIT) using the threshold of 10 µg Hb/g of faeces and data from follow-up were retrieved from electronic medical records of the public hospitals involved in the research. We determined the cumulative risk of GIC, CRC and upper GIC. Hazard rate (HR) was calculated adjusted by age, sex and presence of significant colonic lesion.
RESULTS: We included 2709 patients without CRC and a complete baseline colonoscopy, 730 (26.9%) with FIT = 10 µgr Hb/gr. During a mean time of 45.5 ± 20.0 mo, a GIC was detected in 57 (2.1%) patients: An upper GIC in 35 (1.3%) and a CRC in 14 (0.5%). Thirty-six patients (1.3%) died due to GIC: 22 (0.8%) due to an upper GIC and 9 (0.3%) due to CRC. FIT-positive subjects showed a higher CRC risk (HR 3.8, 95%CI: 1.2-11.9) with no differences in GIC (HR 1.5, 95%CI: 0.8-2.7) or upper GIC risk (HR 1.0, 95%CI: 0.5-2.2). Patients with a positive FIT had only an increased risk of CRC-related death (HR 10.8, 95%CI: 2.1-57.1) and GIC-related death (HR 2.2, 95%CI: 1.1-4.3), with no differences in upper GIC-related death (HR 1.4, 95%CI: 0.6-3.3). An upper GIC was detected in 22 (0.8%) patients during the first year. Two variables were independently associated: anaemia (OR 5.6, 95%CI: 2.2-13.9) and age = 70 years (OR 2.7, 95%CI: 1.1-7.0).
CONCLUSION: Symptomatic patients without CRC have a moderate risk increase in upper GIC, regardless of the FIT result. Patients with a positive FIT have an increased risk of post-colonoscopy CRC.
Idioma: Inglés
DOI: 10.3748/wjg.v26.i1.70
Año: 2020
Publicado en: World Journal of Gastroenterology 26, 1 (2020), 70-85
ISSN: 1007-9327
Factor impacto JCR: 5.742 (2020)
Categ. JCR: GASTROENTEROLOGY & HEPATOLOGY rank: 28 / 92 = 0.304 (2020) - Q2 - T1
Factor impacto SCIMAGO: 1.427 - Medicine (miscellaneous) (Q1) - Gastroenterology (Q1)
Financiación: info:eu-repo/grantAgreement/EUR/ERDF-ESF/Investing in your future
Financiación: info:eu-repo/grantAgreement/EUR/ISCII-ERDF/A way to make Europe
Financiación: info:eu-repo/grantAgreement/ES/ISCIII-ERDF-FSE/PI17-00837
Tipo y forma: Article (Published version)
Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)
You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes.
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AIM: To assess the risk of GIC detection and related death in FIT-positive symptomatic patients (threshold 10 µg Hb/g faeces) without CRC.
METHODS: Post hoc cohort analysis performed within two prospective diagnostic test studies evaluating the diagnostic accuracy of different FIT analytical systems for CRC and significant colonic lesion detection. Ambulatory patients with gastrointestinal symptoms referred consecutively for colonoscopy from primary and secondary healthcare, underwent a quantitative FIT before undergoing a complete colonoscopy. Patients without CRC were divided into two groups (positive and negative FIT) using the threshold of 10 µg Hb/g of faeces and data from follow-up were retrieved from electronic medical records of the public hospitals involved in the research. We determined the cumulative risk of GIC, CRC and upper GIC. Hazard rate (HR) was calculated adjusted by age, sex and presence of significant colonic lesion.
RESULTS: We included 2709 patients without CRC and a complete baseline colonoscopy, 730 (26.9%) with FIT = 10 µgr Hb/gr. During a mean time of 45.5 ± 20.0 mo, a GIC was detected in 57 (2.1%) patients: An upper GIC in 35 (1.3%) and a CRC in 14 (0.5%). Thirty-six patients (1.3%) died due to GIC: 22 (0.8%) due to an upper GIC and 9 (0.3%) due to CRC. FIT-positive subjects showed a higher CRC risk (HR 3.8, 95%CI: 1.2-11.9) with no differences in GIC (HR 1.5, 95%CI: 0.8-2.7) or upper GIC risk (HR 1.0, 95%CI: 0.5-2.2). Patients with a positive FIT had only an increased risk of CRC-related death (HR 10.8, 95%CI: 2.1-57.1) and GIC-related death (HR 2.2, 95%CI: 1.1-4.3), with no differences in upper GIC-related death (HR 1.4, 95%CI: 0.6-3.3). An upper GIC was detected in 22 (0.8%) patients during the first year. Two variables were independently associated: anaemia (OR 5.6, 95%CI: 2.2-13.9) and age = 70 years (OR 2.7, 95%CI: 1.1-7.0).
CONCLUSION: Symptomatic patients without CRC have a moderate risk increase in upper GIC, regardless of the FIT result. Patients with a positive FIT have an increased risk of post-colonoscopy CRC.
Idioma: Inglés
DOI: 10.3748/wjg.v26.i1.70
Año: 2020
Publicado en: World Journal of Gastroenterology 26, 1 (2020), 70-85
ISSN: 1007-9327
Factor impacto JCR: 5.742 (2020)
Categ. JCR: GASTROENTEROLOGY & HEPATOLOGY rank: 28 / 92 = 0.304 (2020) - Q2 - T1
Factor impacto SCIMAGO: 1.427 - Medicine (miscellaneous) (Q1) - Gastroenterology (Q1)
Financiación: info:eu-repo/grantAgreement/EUR/ERDF-ESF/Investing in your future
Financiación: info:eu-repo/grantAgreement/EUR/ISCII-ERDF/A way to make Europe
Financiación: info:eu-repo/grantAgreement/ES/ISCIII-ERDF-FSE/PI17-00837
Tipo y forma: Article (Published version)
Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)
You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. Exportado de SIDERAL (2021-09-02-08:45:07)
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Record created 2020-10-23, last modified 2021-09-02