Positive Fecal Immunochemical Test Strongly Predicts Adenomas in Younger Adults With Fatty Liver and Metabolic Syndrome

Abstract

INTRODUCTION: The incidence of early-onset colorectal cancer is increasing. This study explored the feasibility of fecal immunochemical test (FIT) and risk factors for predicting colorectal neoplasm in younger adults. METHODS: This single-center study included 6,457 participants who underwent health examination from 2013 to 2016 including index colonoscopy (3,307 individuals aged 30–49 years as the younger adult group and 3,150 aged ≥50 years as the average-risk group). Primary outcomes were adenoma detection rate (ADR) and advanced ADR (AADR). Findings of younger participants were stratified by the results of FIT and clinical risk factors and were compared with those of the average-risk group. RESULTS: Among participants aged 30–49 years, a positive FIT was associated with significantly higher ADR (28.5% vs 15.5, P < 0.001) and AADR (14.5% vs 3.7%, P < 0.001) than a negative FIT. Moreover, a positive FIT was associated with higher AADR in younger participants than in average-risk counterparts (14.5% vs 9.8%, P = 0.028). Although no single risk factor predicted FIT positivity in younger participants, nonalcoholic fatty liver disease was independently associated with higher ADR (odds ratio = 2.60, 95% confidence interval = 1.27–5.34, P = 0.001), and metabolic syndrome was independently predictive of higher AADR in younger participants than in average-risk participants (odds ratio = 3.46, 95% confidence interval = 1.66–7.21, P = 0.001). DISCUSSION: A positive FIT in people aged 30–49 years implies a higher risk of colorectal neoplasm, particularly among patients with nonalcoholic fatty liver disease and metabolic syndrome.

Performance of the Fecal Immunochemical Test in Detecting Advanced Colorectal Neoplasms and Colorectal Cancers in People Aged 40–49 Years: A Systematic Review and Meta-Analysis

“…All enrolled studies were retrospective cohort analyses, most of which included individuals who participated in health checkups or CRC screening programs, except for that of D'Souza et al [22], which focused on patients with symptoms who took FITs. Colonoscopy was offered to all participants in some studies [23][24][25][26][27] but only for people with positive FIT results in others [22,[28][29][30][31]. Adenoma detection for the average-risk group ranged from 28.2% to 33% [22,24,26,27].…”

“…Colonoscopy was offered to all participants in some studies [23][24][25][26][27] but only for people with positive FIT results in others [22,[28][29][30][31]. Adenoma detection for the average-risk group ranged from 28.2% to 33% [22,24,26,27].…”

“…In total, 664,159 FITs (35.6% were younger-age group) were included in the studies, and the pooled FIT positivity rate was 4.9% for the younger age group and 7.3% for the average-risk group. Most of the studies used FITs from the OC-SENSOR series [24][25][26][27][28][29][30][31] (Eiken Chemical, Tokyo, Japan); Magstream/Hem SP [23] (Fujirebio, Tokyo, Japan) and HM-Jack analyzer [22] (Hitachi Chemical Diagnostics Systems, Tokyo, Japan) models were the next most common. The cutoff FIT values were either 10 or 20 µg Hb/g feces (Table 1).…”

Metabolisches Syndrom und gastrointestinale Krebsvorsorge

“…Bislang ist dies nicht der Fall: Innerhalb von 10 Jahren nutzen in Deutschland weniger als 20 % der Anspruchsberechtigten das Angebot einer Vorsorgekoloskopie. Angesichts der geringen Teilnahmeraten wird bei MetS-Patienten also dem niederschwelligen immunologischen Stuhltest (immunologischer fäkaler Okkultbluttest: iFOBT oder fäkaler immunochemischer Test: FIT) eine besondere Bedeutung zukommen [42].…”

“…So treten beim MetS kolorektale Adenome um 50-76 % häufiger auf [35,38,39,40] und dies bereits vor dem 50. Lebensjahr [38,41,42]. Diese Beobachtungen stützen die Hypothese einer in jüngerem Alter höheren Vulnerabilität für die Effekte potenziell karzinogener Metabolite.…”