Faecal occult blood loss accurately predicts future detection of colorectal cancer. A prognostic model. Issue 1 (10th May 2022)

• Record Type: Journal Article
• Authors: Meester, Reinier G S; van de Schootbrugge-Vandermeer, Hilliene J; Breekveldt, Emilie C H; de Jonge, Lucie; Toes-Zoutendijk, Esther; Kooyker, Arthur; Nieboer, Daan; Ramakers, Christian R; Spaander, Manon C W; van Vuuren, Anneke J; Kuipers, Ernst J; van Kemenade, Folkert J; Nagtegaal, Iris D; Dekker, Evelien; van Leerdam, Monique E; Lansdorp-Vogelaar, Iris
• Is Part Of: Gut. Volume 72:Issue 1(2023)
• Page Start: 101
• Page End: 108
• Publication Date: 2022-05-10
• Subjects: colorectal neoplasm -- screening -- stool markers; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2022-327188
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : 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.