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Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy: Role of faecal immunochemical test

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....

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Autores principales: Pin-Vieito, Noel, Iglesias, María J, Remedios, David, Rodríguez-Alonso, Lorena, Rodriguez-Moranta, Francisco, Álvarez-Sánchez, Victoria, Fernández-Bañares, Fernando, Boadas, Jaume, Martínez-Bauer, Eva, Campo, Rafael, Bujanda, Luis, Ferrandez, Ángel, Piñol, Virginia, Rodríguez-Alcalde, Daniel, Guardiola, Jordi, Cubiella, Joaquín, on behalf of the COLONPREDICT study investigators
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952298/
https://www.ncbi.nlm.nih.gov/pubmed/31933515
http://dx.doi.org/10.3748/wjg.v26.i1.70
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author Pin-Vieito, Noel
Iglesias, María J
Remedios, David
Rodríguez-Alonso, Lorena
Rodriguez-Moranta, Francisco
Álvarez-Sánchez, Victoria
Fernández-Bañares, Fernando
Boadas, Jaume
Martínez-Bauer, Eva
Campo, Rafael
Bujanda, Luis
Ferrandez, Ángel
Piñol, Virginia
Rodríguez-Alcalde, Daniel
Guardiola, Jordi
Cubiella, Joaquín
on behalf of the COLONPREDICT study investigators,
author_facet Pin-Vieito, Noel
Iglesias, María J
Remedios, David
Rodríguez-Alonso, Lorena
Rodriguez-Moranta, Francisco
Álvarez-Sánchez, Victoria
Fernández-Bañares, Fernando
Boadas, Jaume
Martínez-Bauer, Eva
Campo, Rafael
Bujanda, Luis
Ferrandez, Ángel
Piñol, Virginia
Rodríguez-Alcalde, Daniel
Guardiola, Jordi
Cubiella, Joaquín
on behalf of the COLONPREDICT study investigators,
author_sort Pin-Vieito, Noel
collection PubMed
description 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.
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spelling pubmed-69522982020-01-13 Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy: Role of faecal immunochemical test Pin-Vieito, Noel Iglesias, María J Remedios, David Rodríguez-Alonso, Lorena Rodriguez-Moranta, Francisco Álvarez-Sánchez, Victoria Fernández-Bañares, Fernando Boadas, Jaume Martínez-Bauer, Eva Campo, Rafael Bujanda, Luis Ferrandez, Ángel Piñol, Virginia Rodríguez-Alcalde, Daniel Guardiola, Jordi Cubiella, Joaquín on behalf of the COLONPREDICT study investigators, World J Gastroenterol Retrospective Cohort Study 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. Baishideng Publishing Group Inc 2020-01-07 2020-01-07 /pmc/articles/PMC6952298/ /pubmed/31933515 http://dx.doi.org/10.3748/wjg.v26.i1.70 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Retrospective Cohort Study
Pin-Vieito, Noel
Iglesias, María J
Remedios, David
Rodríguez-Alonso, Lorena
Rodriguez-Moranta, Francisco
Álvarez-Sánchez, Victoria
Fernández-Bañares, Fernando
Boadas, Jaume
Martínez-Bauer, Eva
Campo, Rafael
Bujanda, Luis
Ferrandez, Ángel
Piñol, Virginia
Rodríguez-Alcalde, Daniel
Guardiola, Jordi
Cubiella, Joaquín
on behalf of the COLONPREDICT study investigators,
Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy: Role of faecal immunochemical test
title Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy: Role of faecal immunochemical test
title_full Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy: Role of faecal immunochemical test
title_fullStr Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy: Role of faecal immunochemical test
title_full_unstemmed Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy: Role of faecal immunochemical test
title_short Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy: Role of faecal immunochemical test
title_sort risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy: role of faecal immunochemical test
topic Retrospective Cohort Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952298/
https://www.ncbi.nlm.nih.gov/pubmed/31933515
http://dx.doi.org/10.3748/wjg.v26.i1.70
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