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Comparison of Colonoscopy, Fecal Immunochemical Test, and Risk-Adapted Approach in a Colorectal Cancer Screening Trial (TARGET-C)
Clinical Gastroenterology and Hepatology ( IF 12.6 ) Pub Date : 2022-08-11 , DOI: 10.1016/j.cgh.2022.08.003
Hongda Chen 1 , Jufang Shi 2 , Ming Lu 1 , Yanjie Li 2 , Lingbin Du 3 , Xianzhen Liao 4 , Donghua Wei 5 , Dong Dong 6 , Yi Gao 7 , Chen Zhu 3 , Rongbiao Ying 8 , Weifang Zheng 9 , Shipeng Yan 4 , Haifan Xiao 4 , Juan Zhang 5 , Yunxin Kong 6 , Furong Li 7 , Shuangmei Zou 10 , Chengcheng Liu 11 , Hong Wang 12 , Yuhan Zhang 1 , Bin Lu 1 , Chenyu Luo 1 , Jie Cai 13 , Jianbo Tian 14 , Xiaoping Miao 14 , Kefeng Ding 15 , Hermann Brenner 16 , Min Dai 1
Affiliation  

Background & Aims

The screening yield and related cost of a risk-adapted screening approach compared with established screening strategies in population-based colorectal cancer (CRC) screening are not clear.

Methods

We randomly allocated 19,373 participants into 1 of the 3 screening arms in a 1:2:2 ratio: (1) one-time colonoscopy (n = 3883); (2) annual fecal immunochemical test (FIT) (n = 7793); (3) annual risk-adapted screening (n = 7697), in which, based on the risk-stratification score, high-risk participants were referred for colonoscopy and low-risk ones were referred for FIT. Three consecutive screening rounds were conducted for both the FIT and the risk-adapted screening arms. Follow-up to trace the health outcome for all the participants was conducted over the 3-year study period. The detection rate of advanced colorectal neoplasia (CRC and advanced precancerous lesions) was the main outcome. The trial was registered in the Chinese Clinical Trial Registry (number: ChiCTR1800015506).

Results

In the colonoscopy, FIT, and risk-adapted screening arms over 3 screening rounds, the participation rates were 42.4%, 99.3%, and 89.2%, respectively; the detection rates for advanced neoplasm (intention-to-treat analysis) were 2.76%, 2.17%, and 2.35%, respectively, with an odds ratio (OR)colonoscopy vs FIT of 1.27 (95% confidence interval [CI]: 0.99–1.63; P = .056), an ORcolonoscopy vs risk-adapted screening of 1.17 (95% CI, 0.91–1.49; P = .218), and an ORrisk-adapted screening vs FIT of 1.09 (95% CI, 0.88–1.35; P = .438); the numbers of colonoscopies needed to detect 1 advanced neoplasm were 15.4, 7.8, and 10.2, respectively; the costs for detecting 1 advanced neoplasm from a government perspective using package payment format were 6928 Chinese Yuan (CNY) ($1004), 5821 CNY ($844), and 6694 CNY ($970), respectively.

Conclusions

The risk-adapted approach is a feasible and cost-favorable strategy for population-based CRC screening and therefore could complement the well-established one-time colonoscopy and annual repeated FIT screening strategies. (Chinese Clinical Trial Registry; ChiCTR1800015506).

更新日期:2022-08-11
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