用于息肉切除术后结直肠癌监测的粪便检测可以安全地减少结肠镜检查：MOCCAS 研究。
Stool-based testing for post-polypectomy colorectal cancer surveillance safely reduces colonoscopies: The MOCCAS study.
发表日期：2024 Aug 28
作者：
Beatriz Carvalho, Willemijn de Klaver, Francine van Wifferen, Meta C J van Lanschot, Alouisa J P van Wetering, Quirine E W van der Zander, Margriet Lemmens, Anne S Bolijn, Marianne Tijssen, Pien Delis-van Diemen, Nikkie Buekers, Kathleen Daenen, Jaleesa van der Meer, Pauline G van Mulligen, Brenda S Hijmans, Sander de Ridder, Lana Meiqari, Mariska Bierkens, René W M van der Hulst, Johan P H Kuyvenhoven, Annemarie M van Berkel, Annekatrien C T M Depla, Monique E van Leerdam, Jeroen M Jansen, Caroline A Wientjes, Jan-Willem A Straathof, Eric T P Keulen, Dewkoemar Ramsoekh, Leon M G Moons, Michael Zacherl, Ad A M Masclee, Meike de Wit, Marjolein J E Greuter, Manon van Engeland, Evelien Dekker, Veerle M H Coupé, Gerrit A Meijer
来源：
GASTROENTEROLOGY
摘要：
基于结肠镜检查的预防结直肠癌 (CRC) 的监测给患者和医疗保健带来了沉重负担。通过将结肠镜检查限制在 AN 风险增加的个体中，粪便测试可能有助于减少结肠镜检查的监测。这项横断面观察性研究包括具有监测指征的 50-75 岁的个体。在肠道准备之前，参与者收集样本进行多目标粪便 DNA (mt-sDNA) 测试和两项粪便免疫化学测试 (FIT)。计算所有监测指标的测试准确度。仅针对息肉切除术后适应症（最常见且与 CRC 风险相对较低相关），使用 ASCCA 模型评估了粪便监测的长期影响。模拟基于粪便的策略来调整每个测试的阳性阈值，以获得至少与结肠镜检查监测一样有效的策略。3453 个人获得了所有粪便测试和结肠镜检查的结果。 2226 人曾接受过息肉切除术，1003 人曾接受过 CRC 治疗，224 人有家族风险。 mt-sDNA 测试的 AN 受试者工作特征曲线下面积为 0.72 (95% CI; 0.69-0.75)，FIT OC-Sensor 为 0.61 (95% CI; 0.58-0.64)，FIT OC-Sensor 为 0.59 (95% CI; 0.58-0.64)。 0.56-0.61) 适用于 FIT FOB-Gold。基于粪便的息肉切除术后监测策略至少与结肠镜检查监测一样有效，将结肠镜检查的次数减少了 15-41%，并且在一个人的一生中需要进行 5.6-9.5 次粪便检查。基于 Mt-sDNA 的监测比结肠镜检查监测成本更高，而基于 FIT 的监测则节省了成本。这项研究表明，基于粪便的息肉切除术后监测策略可能是安全且具有成本效益的，有可能减少结肠镜检查的次数高达 41%。版权所有 © 2024 AGA Institute。由爱思唯尔公司出版。保留所有权利。
Colonoscopy-based surveillance to prevent colorectal cancer (CRC) causes substantial burden for patients and healthcare. Stool tests may help to reduce surveillance colonoscopies, by limiting colonoscopies to individuals at increased risk of AN.This cross-sectional observational study included individuals aged 50-75 with surveillance indication. Before bowel preparation, participants collected samples for a multitarget stool DNA (mt-sDNA) test and two fecal immunochemical tests (FITs). Test accuracies were calculated for all surveillance indications. Only for the post-polypectomy indication, most common and associated with a relatively low CRC risk, long-term impact of stool-based surveillance was evaluated with the ASCCA model. Stool-based strategies were simulated to tune each tests' positivity threshold to obtain strategies at least as effective as colonoscopy surveillance.3453 individuals had results for all stool tests and colonoscopy. 2226 had previous polypectomy, 1003 previous CRC and 224 familial risk. Areas under the receiver operating characteristic curve for AN were 0.72 (95% CI; 0.69-0.75) for the mt-sDNA test, 0.61 (95% CI; 0.58-0.64) for the FIT OC-Sensor and 0.59 (95% CI; 0.56-0.61) for the FIT FOB-Gold. Stool-based post-polypectomy surveillance strategies at least as effective as colonoscopy surveillance, reduced the number of colonoscopies by 15-41% and required 5.6-9.5 stool tests over the lifetime of a person. Mt-sDNA-based surveillance was more costly than colonoscopy surveillance, whereas FIT-based surveillance saved costs.This study shows that stool-based post-polypectomy surveillance strategies can be safe and cost-effective, with potential to reduce the number of colonoscopies by up to 41%.Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.