Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2021; 27(31): 5272-5287
Published online Aug 21, 2021. doi: 10.3748/wjg.v27.i31.5272
Prediction of the severity of colorectal lesion by fecal hemoglobin concentration observed during previous test in the French screening program
Christian Balamou, Akoï Koïvogui, Christelle M Rodrigue, Aurélie Clerc, Claire Piccotti, Anne Deloraine, Catherine Exbrayat
Christian Balamou, Christelle M Rodrigue, Site de l'Ain, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Bourg-en-Bresse 01000, France
Akoï Koïvogui, Site de Seine-Saint-Denis, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France, Bondy 93146, France
Aurélie Clerc, Anne Deloraine, Sites Savoie & Haute Savoie, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Chambéry 73000, France
Claire Piccotti, Site de Drôme Ardèche, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Valence 26000, France
Catherine Exbrayat, Site Isère & Drôme-Ardèche, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Meylan 38240, France
Author contributions: The study was conceived and designed by Balamou C and Koïvogui A; the data was acquired and collated by Balamou C, Clerc A, Piccotti C, Deloraine A, and Exbrayat C; the data were analyzed by Balamou C, Koïvogui A, and Rodrigue CM; the study was drafted and revised critically by all authors; All authors gave final approval of the version to be published and have contributed to the study.
Institutional review board statement: This study is co-signed by the heads of the structures involved, as such, no further Institutional Review Board was required.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that was obtained after each patient agreed to participate in screening campaigns.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Data and materials are available when requested by e-mail. However, each request will be processed in accordance with French legislation on the availability of research data.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that 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. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Christian Balamou, MD, MHSc, MSc, Doctor, Site de l'Ain, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, 58 rue Robespierre, Bourg-en-Bresse 01000, France. cbalamou@yahoo.fr
Received: February 12, 2021
Peer-review started: February 12, 2021
First decision: April 18, 2021
Revised: May 3, 2021
Accepted: July 20, 2021
Article in press: July 20, 2021
Published online: August 21, 2021
Processing time: 186 Days and 14.8 Hours
Abstract
BACKGROUND

The rate of positive tests using fecal immunochemical test (FIT) does not decrease with subsequent campaigns, but the positive predictive value of advanced neoplasia significantly decreases in subsequent campaign after a first negative test. A relationship between the fecal hemoglobin concentration (Fhb) and the opportunity to detect a colorectal cancer in subsequent campaign has been shown.

AIM

To predict the severity of colorectal lesions based on Fhb measured during previous colorectal cancer screening campaign.

METHODS

This etiological study included 293750 patients aged 50-74, living in Auvergne-Rhône-Alpes (France). These patients completed at least two FIT [test(-1) and test(0)] between June 2015 and December 2019. Delay between test(-1) and test(0) was > 1 year and test(-1) result was negative (< 150 ngHb/mL). The severity of colorectal lesions diagnosed at test(0) was described according to Fhb measured at test(-1) [Fhb(-1)]. The relationship between the severity classified in seven ordinal categories and the predictive factors was analyzed in an ordered multivariate polytomous regression model.

RESULTS

The test(0) positive rate was 4.0%, and the colonoscopy completion rate was 97.1% in 11594 patients who showed a positive test(0). The colonoscopy detection rate was 77.7% in those 11254 patients who underwent a colonoscopy. A total of 8748 colorectal lesions were detected (including 2182 low-risk-polyps, 2400 high-risk-polyp, and 502 colorectal cancer). The colonoscopy detection rate varied significantly with Fhb(-1) [0 ngHb/mL: 75.6%, (0-50 ngHb/mL): 77.3%, (50-100 ngHb/mL): 88.7%, (100-150 ngHb/mL): 90.3%; P = 0.001]. People with a Fhb(-1) within (100-150 ngHb/mL) (P = 0.001) were 2.6 (2.2; 3.0) times more likely to have a high severity level compared to those having a Fhb(-1) value of zero. This risk was reduced by 20% in patients aged 55-59 compared to those aged < 55 [adjusted odds ratio: 0.8 (0.6; 1.0)].

CONCLUSION

The study showed that higher Fhb(-1) is correlated to an increased risk of severity of colorectal lesions. This risk of severity increased among first-time participants (age < 55) and the elderly (≥ 70). To avoid the loss of chance in these age groups, the FIT positivity threshold should be reduced to 100 ngHb/mL. The other alternative would be to reduce the time between the two tests in these age groups from the current 2 years to 1 year.

Keywords: Colorectal cancer screening; Fecal immunochemical test; Fecal hemoglobin concentration; Colorectal lesion severity

Core Tip: The study showed that the severity of the colonic lesions increases with a high concentration of fecal hemoglobin measured in previous test. The elderly (≥ 70 years) had a high proportion of positive colonoscopy when the fecal hemoglobin concentration measured in previous campaign was between 100 and 150 ngHb/mL. Younger patients (age < 54) were likely to have a high-severity neoplasia. Given these results, the recommendation to reduce the FIT positivity threshold to 100 ngHb/mL for first-time participants and the elderly (aged ≥ 70) should attract the attention of the decision-making authority.