Biology and Clinical Implications of Fecal Occult Blood Test Screen-Detected Colorectal Cancer.
Journal
JNCI cancer spectrum
ISSN: 2515-5091
Titre abrégé: JNCI Cancer Spectr
Pays: England
ID NLM: 101721827
Informations de publication
Date de publication:
05 01 2022
05 01 2022
Historique:
accepted:
11
11
2021
received:
06
07
2021
revised:
11
07
2021
entrez:
14
6
2022
pubmed:
15
6
2022
medline:
18
6
2022
Statut:
ppublish
Résumé
Fecal occult blood test (FOBT)-based screening for colorectal cancer (CRC) reduces mortality, with earlier stage at diagnosis a prominent feature. Other characteristics of FOBT screen-detected cancers and any implications for clinical management have not been well explored. We examined a multisite clinical registry to compare the characteristics and outcomes of FOBT screen-detected CRC via the Australian National Bowel Cancer Screening Program (NBCSP), which is offered biennially to individuals aged 50-74 years, and age-matched non-screen-detected CRC in the same registry. All statistical tests were 2-sided. Odds ratios (ORs) were calculated using the Baptista-Pike method, and hazard ratios via the log-rank method. Of 7153 registry patients diagnosed June 1, 2006, to June 30, 2020, 4142 (57.9%) were aged between 50 and 74 years. Excluding 406 patients with non-NBCSP screen-detected cancers and 35 patients with unknown method of detection, 473 (12.8%) were screen detected via the NBCSP, and 3228 (87.2%) were non-screen detected. Screen-detected patients were younger (mean age = 62.4 vs 64.2 years; P < .001) and more medically fit (OR for ASA score 1-2 = 1.91, 95% confidence interval [CI] = 1.51 to 2.41; P < .001). Pathologic characteristics within each stage favored the screen-detected patients. Stage III screen-detected colon cancers were more likely to receive adjuvant therapy (OR = 3.58, 95% CI = 1.52 to 8.36; P = .002). Screen-detected patients had superior relapse-free (hazard ratio = 0.41, 95% CI = 0.29 to 0.60; P < .001) and overall survival (hazard ratio = 0.22, 95% CI = 0.15 to 0.35; P < .001), which was maintained in matched stage comparisons and multivariable analysis. Beyond stage at diagnosis, multiple other factors associated with a favorable outcome are observed in FOBT screen-detected CRC. Given the substantial stage-by-stage differences in survival outcomes, if independently confirmed, individualized adjuvant therapy and surveillance strategies could be warranted for FOBT screen-detected cancers.
Sections du résumé
BACKGROUND
Fecal occult blood test (FOBT)-based screening for colorectal cancer (CRC) reduces mortality, with earlier stage at diagnosis a prominent feature. Other characteristics of FOBT screen-detected cancers and any implications for clinical management have not been well explored.
METHODS
We examined a multisite clinical registry to compare the characteristics and outcomes of FOBT screen-detected CRC via the Australian National Bowel Cancer Screening Program (NBCSP), which is offered biennially to individuals aged 50-74 years, and age-matched non-screen-detected CRC in the same registry. All statistical tests were 2-sided. Odds ratios (ORs) were calculated using the Baptista-Pike method, and hazard ratios via the log-rank method.
RESULTS
Of 7153 registry patients diagnosed June 1, 2006, to June 30, 2020, 4142 (57.9%) were aged between 50 and 74 years. Excluding 406 patients with non-NBCSP screen-detected cancers and 35 patients with unknown method of detection, 473 (12.8%) were screen detected via the NBCSP, and 3228 (87.2%) were non-screen detected. Screen-detected patients were younger (mean age = 62.4 vs 64.2 years; P < .001) and more medically fit (OR for ASA score 1-2 = 1.91, 95% confidence interval [CI] = 1.51 to 2.41; P < .001). Pathologic characteristics within each stage favored the screen-detected patients. Stage III screen-detected colon cancers were more likely to receive adjuvant therapy (OR = 3.58, 95% CI = 1.52 to 8.36; P = .002). Screen-detected patients had superior relapse-free (hazard ratio = 0.41, 95% CI = 0.29 to 0.60; P < .001) and overall survival (hazard ratio = 0.22, 95% CI = 0.15 to 0.35; P < .001), which was maintained in matched stage comparisons and multivariable analysis.
CONCLUSIONS
Beyond stage at diagnosis, multiple other factors associated with a favorable outcome are observed in FOBT screen-detected CRC. Given the substantial stage-by-stage differences in survival outcomes, if independently confirmed, individualized adjuvant therapy and surveillance strategies could be warranted for FOBT screen-detected cancers.
Identifiants
pubmed: 35699496
pii: 6502287
doi: 10.1093/jncics/pkab100
pmc: PMC8857921
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press.
Références
Br J Cancer. 2014 Nov 25;111(11):2076-81
pubmed: 25247322
Lancet. 1996 Nov 30;348(9040):1467-71
pubmed: 8942774
J Clin Oncol. 2010 Jul 10;28(20):3219-26
pubmed: 20498393
N Engl J Med. 2005 Jun 30;352(26):2696-704
pubmed: 15987918
Clin Colorectal Cancer. 2018 Dec;17(4):e699-e709
pubmed: 30205948
JAMA Oncol. 2020 Apr 1;6(4):547-551
pubmed: 32053133
N Engl J Med. 2018 Mar 29;378(13):1177-1188
pubmed: 29590544
Intern Med J. 2016 Feb;46(2):166-71
pubmed: 26418334
CA Cancer J Clin. 2017 May 6;67(3):177-193
pubmed: 28248415
J Clin Oncol. 2007 Jun 1;25(16):2198-204
pubmed: 17470851
N Engl J Med. 2004 Jun 3;350(23):2343-51
pubmed: 15175436
N Engl J Med. 2000 Nov 30;343(22):1603-7
pubmed: 11096167
J Natl Cancer Inst. 2007 Mar 21;99(6):433-41
pubmed: 17374833
Br J Surg. 2008 Aug;95(8):1029-36
pubmed: 18563785
Lancet. 1996 Nov 30;348(9040):1472-7
pubmed: 8942775
Am J Epidemiol. 2008 Jul 1;168(1):98-104
pubmed: 18504245
J Oncol Pract. 2017 Apr;13(4):233-241
pubmed: 28399381
J Natl Cancer Inst. 1993 Aug 18;85(16):1311-8
pubmed: 8340943
Gut. 2012 Jul;61(7):1036-40
pubmed: 22052062
N Engl J Med. 2013 Sep 19;369(12):1106-14
pubmed: 24047060
CA Cancer J Clin. 2018 Nov;68(6):394-424
pubmed: 30207593
Med J Aust. 2009 Oct 5;191(7):378-81
pubmed: 19807627
J Clin Oncol. 2011 Apr 10;29(11):1465-71
pubmed: 21383294
Lancet. 1989 May 27;1(8648):1160-4
pubmed: 2566735