Quantile-based fecal hemoglobin concentration for assessing colorectal neoplasms with 1,263,717 Taiwanese screenees

Abstract

Background Although fecal hemoglobin concentration (f-Hb) was highly associated with the risk of colorectal neoplasms, current studies on this subject are hampered by skewedness of the data and the ordinal property of f-Hb has not been well studied yet. Our aim was to develop a quantile-based method to estimate adjusted percentiles (median) of fecal hemoglobin concentration and their derived prediction for the risk of multistage outcomes of colorectal disease. Methods We used a 6-year follow-up cohort of Taiwanese nationwide colorectal screening program with fecal immunochemical testing (FIT) to obtain fecal hemoglobin concentration and applied accelerated failure time multi-variable analyses to make the comparison of adjusted median and other percentitles of fecal hemoglobin across four categories of colorectal carcinogenesis. We then predicted the risk of colorectal neoplasms on the basis of the corresponding percentile values by using accelerated failure time model with Bayesian inversion method. Results The adjusted median fecal hemoglobin concentration of nonadvanced adenoma, advanced adenoma, and colorectal cancer were 57, 82, and 163 μg/g feces as opposed to 0 μg/g feces for the normal group. At 90 μg/g of f-Hb, the highly suspected cut-off for colorectal disease, the risks were 17% for non-advanced adenoma, 6% for advanced adenoma, and 9% for CRC. Life-time risks of each colorectal neoplasm were derived by percentiles of fecal hemoglobin concentration. Conclusion Covariate-adjusted risk stratification for multistage outcomes of colorectal neoplasia were provided by using the quantiles of fecal hemoglobin concentration, yielding the estimated life-time risks of 25th to 75th quantitles, ranging from 0.5 to 44% for colorectal cancer, 0.2 to 46% for non-advanced adenoma, and 0.1 to 20% for advanced adenoma. Electronic supplementary material The online version of this article (10.1186/s12911-019-0812-1) contains supplementary material, which is available to authorized users.

The Synthetic Myeloperoxidase Inhibitor AZD3241 Ameliorates Dextran Sodium Sulfate Stimulated Experimental Colitis

“…Fecal hemoglobin, a surrogate measure for the presence of blood, is considered a reliable predictor of advanced colorectal neoplasia (Garcia et al, 2015;Navarro et al, 2019;Peng et al, 2019). Here we demonstrated that fecal Hb decreased significantly in mice supplemented AZD3241 vs mice treated with DSS alone, once again aligning with the concomitant preservation of colon surface epithelium and diminished rectal bleeding observed for the same mice.…”

Risk‐stratified strategies in population screening for colorectal cancer

“…Several studies have shown that faecal haemoglobin (Hb) concentrations in previous screening rounds are highly predictive for future detection of advanced neoplasia. 39 , 40 , 41 , 42 , 43 , 44 Individuals who tested just below the cut‐off for a positive test had an 8 to 38 higher odds or hazard of being detected with advanced neoplasia vs those without any detectable Hb, depending on the cut‐off used. The lower estimate comes from a study using a 10 μg Hb/g faeces cut‐off, while in the study with the higher estimate a cut‐off of 80 μg Hb/g faeces was used.…”