Background & Aims

The Asia-Pacific Colorectal Screening (APCS) scoring system was developed to stratify the risk of colorectal advanced neoplasm (AN). We aimed to evaluate the performance of the APCS score combined with a stool DNA test used for colorectal cancer screening.

Methods

A total of 2842 subjects who visited outpatient clinics or cancer screening centers were enrolled. Age, sex, smoking status, and family history were recorded and APCS scores were calculated in 2439 participants. A stool DNA test (SDC2 and SFRP2 tests) and fecal immunochemical test (FIT) were performed and colonoscopy was used as the gold standard among 2240 subjects who completed all study procedures. We used a threshold of 4.4 μg/g for the FIT, in addition to the manufacturer’s recommended threshold of 20 μg/g to match the specificity of a stool DNA test.

Results

Based on the APCS score, 38.8% (946 of 2439) of the subjects were categorized as high risk, and they had a 1.8-fold increase in risk for AN (95% CI, 1.4–2.3) compared with low and moderate risk. The APCS combined with the stool DNA test detected 95.2% of invasive cancers (40 of 42) and 73.5% of ANs (253 of 344), while the colonoscopy workload was only 47.1% (1056 of 2240). The sensitivity for AN of APCS combined with stool DNA test was significantly higher than that of APCS combined with FIT (73.5% vs 62.8% with FIT cut-off value of 20 μg/g, and 73.5% vs 68.0% with FIT cut-off value of 4.4 μg/g; both P < .01).

Conclusions

The APCS score combined with a stool DNA test significantly improved the detection of colorectal ANs, while limiting colonoscopy resource utilization (Chictr.org.cn, ChiCTR-DDD-17011169).

中文翻译：

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亚太结直肠筛查评分联合粪便DNA检测提高结直肠晚期肿瘤的检出率

背景与目标

开发亚太结直肠筛查 (APCS) 评分系统是为了对结直肠晚期肿瘤 (AN) 的风险进行分层。我们的目的是评估 APCS 评分与用于结直肠癌筛查的粪便 DNA 测试相结合的性能。

方法

共招募了 2842 名到门诊诊所或癌症筛查中心就诊的受试者。记录了 2439 名参与者的年龄、性别、吸烟状况和家族史，并计算了 APCS 评分。在完成所有研究程序的 2240 名受试者中，进行了粪便 DNA 检测（SDC2和SFRP2检测）和粪便免疫化学检测 (FIT)，并使用结肠镜检查作为金标准。除了制造商推荐的 20 μg/g 阈值以匹配粪便 DNA 测试的特异性外，我们还为 FIT 使用了 4.4 μg/g 的阈值。

结果

根据 APCS 评分，38.8%（2439 人中的 946 人）的受试者被归类为高风险，与低风险和中度风险相比，他们患 AN 的风险增加了 1.8 倍（95% CI，1.4-2.3）。APCS 结合粪便 DNA 检测检测出 95.2% 的浸润性癌症（42 例中的 40 例）和 73.5% 的 AN（344 例中的 253 例），而结肠镜检查的工作量仅为 47.1%（2240 例中的​​ 1056 例）。APCS联合粪便DNA检测对AN的敏感性显着高于APCS联合FIT（73.5% vs 62.8% FIT cut-off值为20 μg/g，73.5% vs 68.0% FIT cut-off）值为 4.4 微克/克；均P < .01）。

结论

APCS 评分与粪便 DNA 检测相结合显着提高了结直肠 AN 的检测率，同时限制了结肠镜检查资源的利用（Chictr.org.cn，ChiCTR-DDD-17011169）。