Prediction of the severity of colorectal lesion by fecal hemoglobin concentration observed during previous test in the French screening program

Table 1 Result of the last test completed, based on the characteristics of the study population

Characteristics	Result of the last test [test(0)]
	Positive test and colonoscopy completion rate			Colonoscopy detection rate		Number of the colorectal lesions
	Nb. (%T+)	P value1	Number T+ (% Colo in T+)	Number Colo (% Positive Colo)	P value1	All lesions	Polyps				CRC
							LRP	HRP		UP	S-0	S-I	S-II	S-III	S-IV	USC
Overall	293750 (4.0)		11594 (97.1)	11254 (77.7)		8748	2182	2400		3664	133	130	53	64	21	101
Fhb(-1) (ngHb/mL)		< 10-3			< 10-3
0	280012 (3.5)		9655 (97.0)	9368 (75.6)		7085	1890	1769		3070	85	99	31	47	15	79
0-50	1680 (10.4)		174 (98.9)	172 (77.3)		133	27	41		56	3	4	1	0	0	1
50–100	8776 (13.0)		1144 (96.9)	1108 (88.7)		983	177	360		370	25	16	12	9	2	12
100-150	3282 (18.9)		621 (97.6)	606 (90.3)		547	88	230		168	20	11	9	8	4	9
gFOBT campaign participation		< 10-3			0.03
Yes-gFOBT	213476 (4.2)		8874 (97.0)	8605 (77.8)		6695	1760	1906		2603	112	109	44	59	17	85
New entrant	40199 (2.9)		1156 (97.5)	1127 (75.1)		846	168	203		456	8	6	0	0	1	4
No-gFOBT	40075 (3.9)		1564 (97.3)	1522 (79.3)		1207	254	291		605	13	15	9	5	3	12
Age (yr) at test(-1)		< 10-3			< 10-3
50-54	57625 (3.0)		1727 (97.9)	1690 (73.7)		1245	276	348		582	10	14	1	6	1	7
55-59	62489 (3.5)		2166 (97.3)	2107 (75.6)		1592	389	445		687	21	19	4	7	3	17
60-64	64141 (3.9)		2514 (97.4)	2449 (78.4)		1920	509		503	807	28	19	17	15	7	15
65-69	63915 (4.7)		2997 (97.0)	2907 (78.7)		2287	592		647	886	38	54	14	17	5	34
≥ 70	45580 (4.8)		2190 (95.9)	2101 (81.1)		1704	416		457	702	36	24	17	19	5	28
Gender		< 10-3			< 10-3
Female	160181 (3.3)		5343 (97.1)	5188 (72.8)		3778	962		937	1663	59	51	15	33	11	47
Male	133569 (4.7)		6251 (97.0)	6066 (81.9)		4970	1220		1,463	2001	74	79	38	31	10	54
Delay (mo) between test(-1) and test(0)		< 10-3			< 10-3
≤ 24	40422 (5.2)		2111 (94.3)	1991 (72.2)		1437	435		435	482	21	23	12	12	0	17
24-30	163470 (4.0)		6538 (97.7)	6390 (76.9)		4916	1322		1440	1833	99	83	29	39	14	57
> 30	89858 (3.3)		2945 (97.6)	2873 (83.4)		2395	425		525	1349	13	24	12	13	7	27
Nb. of tests completed before test(-1)		< 10-3			0.01
0	68839 (3.5)		2421 (97.1)	2351 (76.1)		1790	396		465	855	19	21	9	5	4	16
1	54790 (3.7)		2044 (97.7)	1996 (77.6)		1548	364		432	667	20	26	6	13	6	14
2	55794 (4.0)		2245 (97.1)	2180 (76.6)		1670	434		472	678	25	17	11	12	2	19
3	56716 (4.4)		2514 (97.3)	2445 (77.9)		1905	553		562	649	34	37	13	24	5	28
4	57611 (4.1)		2370 (96.3)	2282 (80.4)		1835	435		469	815	35	29	14	10	4	24

¹Pearson Chi-2 test or Fisher's exact test. Fhb₍₀₎: Fecal hemoglobin measured at test₍₀₎ (last screening test); Fhb_(-1): Fecal hemoglobin measured at test_(-1) (penultimate test); CRC: Colorectal cancer; Colo: Colonoscopy; gFOBT: Guaiac fecal occult blood test; HRP: High risk polyps; LRP: Low risk polyps; UP: Unspecified-polyp; USC: Unspecified stage of colorectal cancer; S-0: Colorectal cancer Stage-0 (pTisN₀M₀), S-I: Stage-I (pT_1-2N₀M₀); S-II: Stage-II (pT₃N₀M₀ or pT₄N₀M₀); S-III: Stage-III (pT₁-T₂N₁M₀ or pT₁N₂M₀ or pT₃-T₄N₁M₀ or pT₂-T₃N₂M₀ or pT₄N₂M₀); S-IV: Stage-IV (any T, any N, M₁); T+: Positive test.

Table 2 Colonoscopy detection rate, number and severity of colorectal lesions according to the previous rate and the last rate of fecal hemoglobin

Fhb(0) by Fhb(-1)			Colonoscopy detection rate		Number of colorectal lesions by Severity
Fhb(-1) (ngHb/mL)	Fhb(0) (ngHb/mL)	Number (% in subtotal)	Number Colo (%Positive Colo)	P value1	Nb. of colorectal lesions	Polyps			CRC
						LRP	HRP	UP	S-0	S-I	S-II	S-III	S-IV	USC
0				0.8
	0	257589 (92.0)
	0-50	1805 (0.6)
	50-100	8275 (3.0)
	100-149	2688 (1.0)
	150-300	4903 (1.7)	4778 (75.5)		3609	980	918	1601	35	38	5	6	2	24
	≥ 300	4752 (1.7)	4590 (75.7)		3476	910	851	1469	50	61	26	41	13	55
	Subtotal	280012 (100.0)	9368 (75.6)		7085	1890	1769	3070	85	99	31	47	15	79
0–50				0.3
	0	1328 (79.1)
	0-50	30 (1.8)
	50-100	112 (6.7)
	100-149	36 (2.1)
	150-300	86 (5.1)	85 (74.1)		63	17	18	24	1	2	1	0	0	0
	≥ 300	88 (5.2)	87 (80.5)		70	10	23	32	2	2	0	0	0	1
	Subtotal	1680 (100.0)	172 (77.3)		133	27	41	56	3	4	1	0	0	1
50–100				0.7
	0	6589 (75.1)
	0-50	106 (1.2)
	50-100	700 (7.9)
	100-149	237 (2.7)
	150-300	540 (6.2)	525 (88.4)		464	97	174	175	7	4	2	2	0	3
	≥ 300	604 (6.9)	583 (89.0)		519	80	186	195	18	12	10	7	2	9
	Subtotal	8776 (100.0)	1108 (88.7)		983	177	360	370	25	16	12	9	2	12
100–149				0.3
	0	2244 (68.4)
	0-50	49 (1.5)
	50-100	259 (7.9)
	100-149	109 (3.3)
	150-300	293 (8.9)	286 (88.8)		254	52	103	87	4	2	3	1	0	2
	≥ 300	328 (10.0)	320 (91.6)		293	36	127	81	16	9	6	7	4	7
	Subtotal	3282 (100.0)	606 (90.3)		547	88	230	168	20	11	9	8	4	9

¹Pearson Chi-2 test or Fisher's exact test. Fhb₍₀₎: Fecal hemoglobin measured at test₍₀₎ (last screening test); Fhb_(-1): Fecal hemoglobin measured at test_(-1) (penultimate test); CRC: Colorectal cancer; Colo: Colonoscopy; HRP: High risk polyps; LRP: Low risk polyps; UP: Unspecified-polyp; USC: Unspecified stage of colorectal cancer; S-0: Colorectal cancer Stage-0 (pTisN₀M₀), S-I: Stage-I (pT_1-2N₀M₀); S-II: Stage-II (pT₃N₀M₀ or pT₄N₀M₀); S-III: Stage-III (pT₁-T₂N₁M₀ or pT₁N₂M₀ or pT₃-T₄N₁M₀ or pT₂-T₃N₂M₀ or pT₄N₂M₀); S-IV: Stage-IV (any T, any N, M₁).

Table 3 Colonoscopy detection rate and proportion of colorectal cancer among colorectal lesions according to the previous rate of fecal hemoglobin and the age at the time of the previous test

Fhb(-1) by age at test(-1)		Colonoscopy detection rate and CRC proportion
		Number Colo (%Positive colo)	P value1	Number of lesions (%CRC)	P value2
Age (yr) at test(-1)	Fhb(-1) (ngHb/mL)
Overall		11254 (77.7)		8748 (5.7)
50-54			<10-3		0.7
	0	1471 (71.6)		1053 (3.1)
	0-50	21 (71.4)		15 (0.0)
	50-100	130 (90.8)		118 (2.5)
	100-150	68 (86.8)		59 (5.1)
	Subtotal	1690 (73.7)		1245 (3.1)
55-59			< 10-3		0.1
	0	1797 (73.7)		1324 (3.9)
	0-50	31 (67.7)		21 (4.8)
	50-100	178 (87.1)		155 (7.1)
	100-150	101 (91.1)		92 (7.6)
	Subtotal	2107 (75.6)		1592 (4.5)
60-64			< 10-3		0.05
	0	2044 (76.4)		1562 (4.6)
	0-50	37 (70.3)		26 (7.7)
	50-100	247 (90.3)		223 (8.1)
	100-150	121 (90.1)		109 (8.3)
	Subtotal	2449 (78.4)		1920 (5.3)
65-69			< 10-3		0.001
	0	2373 (76.5)		1815 (6.2)
	0-50	54 (90.7)		49 (8.2)
	50-100	308 (88)		271 (8.1)
	100-150	172 (88.4)		152 (15.8)
	Subtotal	2907 (78.7)		2287 (7.1)
≥70			< 10-3		0.01
	0	1683 (79.1)		1331 (6.5)
	0-50	29 (75.9)		22 (9.1)
	50-100	245 (88.2)		216 (10.2)
	100-150	144 (93.8)		135 (13.3)
	Subtotal	2101 (81.1)		1704 (7.6)

¹Pearson Chi-2 test.

²Fisher's exact test. CRC: Colorectal cancer; Colo: Colonoscopy; Fhb_(-1): Fecal hemoglobin measured at test_(-1) (penultimate test).

Table 4 Number of colorectal lesions and the proportion of colorectal cancer among colorectal lesions by localization, according to the previous rate and the last rate of fecal hemoglobin

Fhb(0) by Fhb(-1)		Colorectal lesion number (%Specified localization)	Number of colorectal lesions by localization and proportion of CRC
			Specified localization: number (% CRC)	Cecum: number (% CRC)	Right colon: number (% CRC)	Transverse colon: number (%CRC)	Left colon: number (%CRC)	Rectosigmoid: number (%CRC)	P value1
Fhb(-1) (ngHb/mL)	Fhb(0) (ngHb/mL)
Overall	150-300	4390 (57.0)	2500 (5.4)	195 (6.7)	490 (5.3)	221 (3.2)	252 (3.2)	1342 (6.1)	0.2
	> 300	4358 (59.7)	2600 (13.4)	179 (16.8)	432 (11.8)	176 (11.4)	235 (11.1)	1578 (14.1)	0.3
	Total	8748 (58.3)	5100 (9.5)	374 (11.5)	922 (8.4)	397 (6.8)	487 (7.0)	2920 (10.4)	0.01
0	150-300	3609 (55.7)	2011 (5.3)	154 (7.8)	391 (5.1)	176 (2.8)	200 (3.0)	1090 (5.8)	0.2
	> 300	3476 (58.2)	2022 (12.0)	145 (14.5)	355 (10.1)	139 (8.6)	185 (10.3)	1198 (12.9)	0.3
	Subtotal	7085 (56.9)	4033 (8.6)	299 (11.0)	746 (7.5)	315 (5.4)	385 (6.5)	2288 (9.5)	0.02
0-50	150-300	63 (61.9)	39 (10.3)	2 (0.0)	6 (16.7)	4 (0.0)	8 (12.5)	19 (10.5)	1.0
	> 300	70 (55.7)	39 (12.8)	2 (0.0)	4 (25.0)	2 (0.0)	3 (0.0)	28 (14.3)	0.8
	Subtotal	133 (58.7)	78 (11.5)	4 (0.0)	10 (20)	6 (0.0)	11 (9.1)	47 (12.8)	0.9
50-100	150-300	464 (62.1)	288 (5.6)	24 (0.0)	66 (4.6)	23 (4.4)	23 (0.0)	152 (7.9)	0.5
	> 300	519 (63.0)	327 (17.1)	22 (27.3)	46 (17.4)	21 (23.8)	29 (10.3)	209 (16.3)	0.5
	Subtotal	983 (62.6)	615 (11.7)	46 (13.0)	112 (9.8)	44 (13.6)	52 (5.8)	361 (12.7)	0.6
100-149	150-300	254 (63.8)	162 (6.2)	15 (6.7)	27 (7.4)	18 (5.6)	21 (4.8)	81 (6.2)	1.0
	> 300	293 (72.4)	212 (21.7)	10 (30.0)	27 (22.2)	14 (21.4)	18 (22.2)	143 (21.0)	1.0
	Subtotal	547 (68.4)	374 (15)	25 (16.0)	54 (14.8)	32 (12.5)	39 (12.8)	224 (15.6)	1.0

¹Pearson Chi-2 test or Fisher's exact test. CRC: Colorectal cancer; Fhb₍₀₎: Fecal hemoglobin measured at test₍₀₎ (last screening test); Fhb_(-1): Fecal hemoglobin measured at test_(-1) (penultimate test).

Table 5 Analysis of the relationship between the diagnosis and severity of colorectal lesions and the predictive factors

Predictive factors	Risk analysis of colorectal lesions in a logistic regression model				Risk analysis of the severity of colorectal lesions in an ordered polytomous regression model
	Univariate		Multivariate		Univariate		Multivariate
	Unadjusted OR (95%CI)	P value1	Adjusted OR (95%CI)	P value1	Unadjusted OR (95%CI)	P value2	Adjusted OR (95%CI)	P value2
Fhb-1 (ngHb/mL) (Ref.: 0)
0-50	1.1 (0.8; 1.6)	0.6	1.1 (0.8; 1.6)	0.5	1.4 (1.0; 2.0)	0.1	1.3 (0.9; 1.8)	0.1
50-100	2.5 (2.1; 3.1)	< 10-3	2.4 (2.0; 3.0)	< 10-3	1.8 (1.6; 2.1)	< 10-3	1.8 (1.6; 2.0)	< 10-3
100-150	3.0 (2.3; 3.9)	< 10-3	2.9 (2.2; 3.8)	< 10-3	2.6 (2.2; 3.1)	< 10-3	2.6 (2.2; 3.0)	< 10-3
gFOBT campaign participation (Ref.: Yes-gFOBT)
New entrant	0.9 (0.7; 1.0)	0.04	3.3 (2.2; 5.0)	< 10-3	0.6 (0.6; 0.8)	< 10-3	0.1 (0.1; 0.2)	< 10-3
No-gFOBT	1.1 (1.0; 1.2)	0.2	2.8 (1.9; 4.1)	< 10-3	0.8 (0.7; 0.9)	< 10-3	0.2 (0.1; 0.3)	< 10-3
Age (yr) at test(-1) (Ref.: 50-54)
55-59	1.1 (1.0; 1.3)	0.2	1.3 (1.0; 1.6)	0.04	1.1 (0.9; 1.3)	0.4	0.8 (0.6; 1.0)	0.02
60-64	1.3 (1.1; 1.5)	< 10-3	1.4 (1.2; 1.8)	0.001	1.0 (0.9; 1.2)	0.5	0.7 (0.6; 0.9)	0.004
65-69	1.3 (1.1; 1.5)	< 10-3	1.4 (1.1; 1.8)	0.002	1.3 (1.1; 1.5)	0.002	0.9 (0.7; 1.1)	0.2
≥ 70	1.5 (1.3; 1.8)	< 10-3	1.7 (1.3; 2.1)	< 10-3	1.2 (1.0; 1.4)	0.01	0.8 (0.6; 1.0)	0.07
Gender (Ref.: Female)
Male	1.7 (1.5; 1.9)	< 10-3	1.7 (1.5; 1.8)	< 10-3	1.2 (1.1; 1.3)	0.002	1.2 (1.1; 1.3)	< 10-3
Delay (mo) between test(-1) and test0 (Ref.: < 24)
24-30	1.3 (1.1; 1.4)	< 10-3	1.3 (1.1; 1.5)	< 10-3	1.0 (0.9; 1.1)	0.9	1.0 (0.9; 1.1)	0.9
> 30	1.9 (1.7; 2.2)	< 10-3	2.1 (1.7; 2.6)	< 10-3	0.6 (0.5; 0.7)	< 10-3	0.6 (0.5; 0.7)	< 10-3
Number of tests completed before test(-1) (Ref.: 0)
1	1.1 (0.9; 1.2)	0.3	2.7 (1.9; 3.9)	< 10-3	1.2 (1.0; 1.4)	0.03	0.3 (0.2; 0.4)	< 10-3
2	1.0 (0.9; 1.2)	0.7	2.7 (1.8; 4.1)	< 10-3	1.2 (1.0; 1.3)	0.03	0.2 (0.1; 0.3)	< 10-3
3	1.1 (1.0; 1.3)	0.1	2.9 (1.9; 4.4)	< 10-3	1.4 (1.2; 1.6)	< 10-3	0.3 (0.2; 0.4)	< 10-3
4	1.3 (1.1; 1.5)	< 10-3	3.5 (2.3; 5.2)	< 10-3	1.1 (1.0; 1.3)	0.1	0.2 (0.1; 0.3)	< 10-3

¹P values were estimated from likelihood ratio tests based on data from 11254 people who completed a colonoscopy.

²P values were estimated from likelihood ratio tests based on data from 8748 people diagnosed with colorectal lesion after colonoscopy. Fhb_(-1): Fecal hemoglobin measured at test_(-1) (penultimate test); gFOBT: Guaiac fecal occult blood test; OR: Odds ratio; CI: Confidence interval.