RT Journal Article
SR Electronic
T1 Faecal occult blood loss accurately predicts future detection of colorectal cancer. A prognostic model
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 101
OP 108
DO 10.1136/gutjnl-2022-327188
VO 72
IS 1
A1 Reinier G S Meester
A1 Hilliene J van de Schootbrugge-Vandermeer
A1 Emilie C H Breekveldt
A1 Lucie de Jonge
A1 Esther Toes-Zoutendijk
A1 Arthur Kooyker
A1 Daan Nieboer
A1 Christian R Ramakers
A1 Manon C W Spaander
A1 Anneke J van Vuuren
A1 Ernst J Kuipers
A1 Folkert J van Kemenade
A1 Iris D Nagtegaal
A1 Evelien Dekker
A1 Monique E van Leerdam
A1 Iris Lansdorp-Vogelaar
A1 ,
YR 2023
UL http://gut.bmj.com/content/72/1/101.abstract
AB Objectives To examine the prognostic potential of repeated faecal haemoglobin (F-Hb) concentration measurements in faecal immunochemical test (FIT)-based screening for colorectal cancer (CRC).Design Prognostic model.Setting Dutch biennial FIT-based screening programme during 2014–2018.Participants 265 881 participants completing three rounds of FIT, with negative test results (F-Hb <47 µg Hb/g faeces) in rounds 1 and 2.Interventions Colonoscopy follow-up in participants with a positive FIT (F-Hb ≥47 µg Hb/g faeces).Main outcomes We evaluated prognostic models for detecting advanced neoplasia (AN) and CRC in round 3, with as predictors, participant age, sex, F-Hb in rounds 1 and 2, and categories/combinations/non-linear transformations of F-Hb. Primary evaluation criteria included: risk prediction accuracy (calibration), discrimination of participants with versus without AN or CRC (optimism-adjusted C-statistics, range 0.5–1.0), the degree of risk stratification and C-statistics in external validation.Results Among study participants, 8806 (3.3%) had a positive FIT result, 3254 (1.2%) had AN detected and 557 (0.2%) had cancer. F-Hb concentrations in rounds 1 and 2 were the strongest outcome predictors, with adjusted ORs of up to 9.4 (95% CI 7.5 to 11.7) for the highest F-Hb category. Risk predictions matched the observed risk for most participants (calibration intercept −0.008 to −0.099; slope 0.982–0.998), and discriminated participants with versus without AN or CRC with C-statistics of 0.78 (95% CI 0.77 to 0.79) and 0.73 (95% CI 0.71 to 0.75), respectively. The predicted risk ranged from 0.4% to 36.7% for AN and from 0.0% to 5.5% for CRC across participants. In external validation, the model retained similar discrimination accuracy for AN (C-statistic 0.77, 95% CI 0.66 to 0.87) and CRC (C-statistic 0.78, 95% CI 0.66 to 0.91).Conclusion Participants at lower versus higher risk of future AN or CRC can be accurately identified based on their age, sex and particularly, prior F-Hb concentrations. Risk stratification should be considered based on this information.Data may be obtained from a third party and are not publicly available. Data for this study cannot be made publicly available, but access can be requested via the Bevolkingsonderzoek Nederlands (BVO-NL). Analysis scripts can be shared by the authors on request.