OBJECTIVES:Long-term colorectal cancer (CRC) monitoring is common in Asia, but assessing colonoscopy effectiveness through adenoma detection rates (ADRs) remains uncommon. This study aimed to identify potential associations between ADR and risk of post-colonoscopy CRC (PCCRC). METHODS:This retrospective, longitudinal, observational study included participants (aged 40-74 years) with initial positive results and subsequent colonoscopy recruited from a community-based, multicentre, CRC screening programme from January 2012 to December 2022 in Tianjin, China. ADR was defined as the proportion of colonoscopies in which at least one adenoma was detected at the provider level. The primary outcome was PCCRC, defined as any CRC diagnosed 6 months after initial colonoscopy. ADR groups were categorised according to quartile distribution (<42%, 42%-55%, 55%-64% and >64%) or dichotomised as at or above vs below the median for statistical analyses. PCCRC incidence rates were expressed as the number of events per 1000 person-years. RESULTS:Among 9957 included participants, 116 PCCRC cases were detected in 33 881 person-years of follow-up. PCCRC incidence rates per 1000 person-years were 4.34, 3.76, 2.62 and 2.69 from the lowest to the highest ADR group, respectively. ADR was significantly inversely associated with PCCRC risk. Participants in the highest ADR group had 49% lower risk of PCCRC than those in the low ADR group (adjusted HR 0.51, 95% CI 0.29 to 0.88). Multivariate-adjusted restricted cubic spline analyses identified a linear dose-response relationship between ADR and PCCRC risk. CONCLUSIONS:This study illustrates the relationship between endoscopist competence, as measured by ADR, and CRC risk after colonoscopy, which can guide assessment of monitoring programmes.

BACKGROUND:In colorectal cancer (CRC) screening programs, accurately identifying individuals at high risk for advanced colorectal neoplasia (ACN) is essential as they require further colonoscopy, early intervention, and monitoring follow-up. This study aimed to develop a machine learning (ML)-based risk prediction model, serving as an effective tool for the early identification of high-risk individuals for ACN. METHODS:This study analyzed data from the Tianjin CRC screening program. The dataset from 2012 to 2022 was divided into a training set and 11 validation sets across 12 medical centers. The 2023 data was used as an independent temporal external validation set. First, the least absolute shrinkage and selection operator and logistic regression (LR) analysis were used to select significant features. Next, six ML models were constructed to predict ACN and validate its predictive capability on the validation sets. Among the classifiers, the best-performing model, Tianjin ML (TML), was selected, and its performance was compared with the Asia Pacific Colorectal Screening (APCS) and LR. Moreover, we developed a stacked ensemble learning model to improve the prediction performance for ACN. Finally, we conducted an interpretability analysis using SHapley Additive exPlanations (SHAP) values and deployed a web application tool based on the Streamlit framework. FINDINGS:Among the trained models, the TML achieved the best performance, with an area under the curve (AUC) of 0.690, a sensitivity of 0.649, a specificity of 0.626, an F1 score of 0.320, and an accuracy of 0.629. Furthermore, the TML performed well in 11 validation sets and the independent temporal external validation set. A predictive probability threshold of 0.140 was identified for stratifying individuals into low- and high-risk groups. The TML exhibited superior performance compared to APCS and LR. The stacked ensemble learning model, S-TML, further improved the AUC to 0.709. Additionally, SHAP analysis identified age, gender, and fecal immunochemical tests as the top three predictive factors for ACN. INTERPRETATION:The TML outperformed traditional models, including APCS and LR, in predicting ACN and could serve as a screening decision support tool to identify high-risk individuals for ACN.

PURPOSETo evaluate the effectiveness of fecal immunochemical testing (FIT) in colorectal cancer screening.METHODSWe conducted a prospective cohort study among 5,598 participants age 40-74 years between 2012 and 2020 in Tianjin, China. Inverse probability weighting was adopted to adjust for potential imbalanced factors between groups. A Cox proportional hazards model was used to estimate the weighted associations between FIT screening and advanced colorectal neoplasia. A difference-in-difference (DID) model was adopted to compare the incidence rates of advanced colorectal neoplasia between groups.RESULTSIn DID analysis, the rate of incidence was reduced by 0.34 cases per person-years in the screening group as compared with the historical FIT screening group (rate ratio [RR], 0.08 [95% CI, 0.07 to 0.10]) and by 0.06 cases per person-years in the non-FIT screening group as compared with the historical non-FIT screening group (RR, 0.37 [95% CI, 0.29 to 0.48]; P < .001 for both comparisons), with a relative reduction of 0.28. Similar benefit effect from FIT screening was observed in sex and age subgroups.CONCLUSIONFIT screening was associated with a reduction in incidence density from advanced colorectal neoplasia.

AbstractBackgroundCurrent guidelines recommend colonoscopy‐based surveillance to decrease the risk of colorectal cancer (CRC) among these participants with above‐average risk. The fecal immunochemical test (FIT) holds promise as a viable alternative surveillance tool, but the existing evidence regarding the use of settings remains limited. Therefore, our aim is to evaluate the CRC incidence rates in individuals with above‐average CRC risk and the relationship between FIT surveillance and CRC incidence.MethodsThe retrospective cohort study was performed based on the CRC screening program between January 2012 and December 2022, in Tianjin, China. This cohort study included 12,515 participants aged 40–74 years with above‐average risk. The primary outcomes were the incidence rates of CRC and advanced colorectal neoplasia which were expressed as the number of events per 100,000 person‐years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models.ResultsWe included 12,515 participants aged 40–74 years, of whom 4980 received subsequent FIT surveillance during the study period. Among these participants, 51 CRC cases occurred in the non‐FIT surveillance group (incidence rate, 233.88 per 100,000 person‐years) and there were 29 cases of CRC in the FIT surveillance group (incidence rate, 184.85 per 100,000 person‐years), resulting in an incidence rate ratio (IRR) of 0.58 (95% CI, 0.37–0.91). Meanwhile, 428 advanced colorectal neoplasia cases were reported in the non‐FIT surveillance group, while 269 cases occurred in the FIT surveillance group, with significantly lower incidence of advanced colorectal neoplasia in the FIT surveillance group (IRR: 0.64; 95% CI, 0.55–0.74). Compared with the non‐FIT surveillance group, the FIT surveillance group had a 54% decreased risk of developing CRC (HR, 0.46; 95% CI, 0.29–0.74) and a 45% decreased risk of developing advanced colorectal neoplasia (HR, 0.55; 95% CI, 0.47–0.64).ConclusionsIn this retrospective cohort study, above‐average risk individuals who received subsequent FIT in the intervals between colonoscopies were associated with a reduction of CRC and advanced colorectal neoplasia incidence, which indicated the value and utility of FIT in the surveillance program.

Background and AimThe incidence of colorectal cancer (CRC) in individuals under 50 is increasing worldwide. We conducted an analysis of colonoscopy findings in high-risk individuals under 50 in the CRC screening program in Tianjin, China, to determine the detection rate and risk factors of advanced adenomas (AA), advanced colorectal neoplasia (ACN), colorectal neoplasia (CN).MethodsOur study investigated individuals aged 40-49 who underwent CRC screening and completed colonoscopy, 2012-2020, while the 50-54 age group served as a control. We compared the detection rates of AA, ACN, and CN among three age groups using univariate and multivariable logistic regression analyses, and investigated the risk factors associated with AA, ACN, and CN among individuals aged 40-49.ResultsWe found a gradual increase in the detection rate of AA, ACN, and CN among individuals aged 40-54. The detection rates for AA (OR 0.58; 95% CI 0.41-0.81), ACN (OR 0.58; 95% CI 0.43-0.77), and CN (OR 0.64; 95% CI 0.56-0.74) were lower in individuals aged 40-44 compared to 45-49. The detection rates of AA (OR 1.08; 95% CI 0.87-1.34) and ACN (OR 1.12; 95% CI 0.93-1.35) in individuals aged 45-49 were comparable with 50-54. Besides, lifestyle factors, BMI, and FIT are not associated with the detection rates of AA, ACN, and CN among individuals aged 40-49.ConclusionsOur study reveals screening data in individuals under 50, indicating comparable detection rates of AA and ACN in individuals aged 45-49 and 50-54. These findings provide valuable data support for optimizing the optimal age to initiate screening. image

BACKGROUND:Compliance with colonoscopy among elderly individuals participating in colorectal cancer (CRC) screening programs is unsatisfactory, despite a high detection rate of bowel-related diseases. In this study, our aim was to analyze the impact of risk factors on the trends of compliance and detection rates in colonoscopy among high-risk individuals aged 60-74. METHODS:A retrospective study was conducted on the high-risk individuals aged 60-74 participating in the 2021 CRC screening program in Tianjin, China. Logistic regression analyses, including both univariate and multivariate analyses, were performed to explore the impact of different risk factors on colonoscopy compliance among the high-risk individuals. Besides, the study investigated the influence of various risk factors on the detection rates of bowel-related diseases among the high-risk individuals who underwent colonoscopy. RESULTS:A total of 24,064 high-risk individuals were included, and 5478 individuals received a free colonoscopy, with an overall compliance of 22.76%. Among them, the adenoma detection rate was 55.46%. Males and individuals with a positive FIT had high compliance and detection rates for CRC, advanced adenomas (AA), advanced colorectal neoplasia (ACN), and colorectal neoplasm (CN). Individuals aged 70-74 were associated with low compliance but high CRC, ACN, and CN detection rates. Individuals who reported a history of chronic constipation, bloody mucous, and CRC in first-degree relative showed high compliance but no significantwere associated with the detection rates of CRC, AA, and CN. CONCLUSION:This study reported several risk factors associated with the screening behaviors for CRC. Patterns and trends in CRC, AA, ACN, and CN compliance and detection rates correlate with risk factors.

We would like to express our gratitude to Safari, Farzad, and Noursina, Ali, for their insightful comments about our article regarding the questionnaire procedure and the assessment of symptoms, including a history of chronic constipation, chronic diarrhea, and mucous blood stools. CRC screening has been carried out in China since the 1970s. The HighRisk Factor Questionnaire (HRFQ) for CRC screening in China was developed based on the CRC General Census conducted twice in Jiashan County and Haining County, Zhejiang Province. This questionnaire has been included in national screening programs since 2007 and has been used in many cities in China.1– 3 Since 2012, CRC screening in community allied thirdgrade classA hospitals has been initiated in Tianjin City, China. First, our screening protocol was developed by the Tianjin CRC Screening Office and conducted in primary care units and medical institutions in Tianjin that perform colonoscopies. Participants identified as high risk were suggested to undergo colonoscopy at designated hospitals through advice notes issued by the screening physicians. Moreover, HRFQ, FIT, and colonoscopy are free and performed at CRC screening units. As for the assessment of symptoms, our HRFQ includes a history of chronic constipation, chronic diarrhea, and mucous bloody stools. These three past symptoms were considered along with a history of adverse life events (e.g., divorce, death of a close relative, etc.), a history of chronic appendicitis or appendectomy, and a history of chronic cholecystitis or gallstones, and the presence of two or more of these was considered as one of the criteria for identifying a highrisk group. Chronic diarrhea is defined in this questionnaire as diarrhea lasting cumulatively more than 3 months in the last 2 years, with each episode lasting more than 1 week; chronic constipation is defined as constipation for more than 2 months per year in the last 2 years. Mucus bloody stools were selfreported by the participants. As stated in the manuscript, only 39.41% of the screening population completed a colonoscopy within 1 month, so those with symptoms at the time of initial screening were advised to seek a definitive diagnosis promptly and were excluded from screening. The data from the screening cohort also revealed that the rate of FIT positivity was lower in individuals with a selfreported history of mucous bloody stools than in those without such a history, and the rate of FIT positivity would likely be higher if symptoms were present at the time of screening (Table 1). The reviewer's point is valid and significant. Our search for keywords “asymptomatic” and “colorectal screening” revealed that some of the inclusion and exclusion criteria for screening in asymptomatic individuals did not consider the relevant history of three symptoms.4– 8 Other articles we found used descriptions related to asymptomatic status, such as reporting no visible rectal bleeding, no change in bowel habits, and no recent or current lower abdominal pain,9 or no abdominal pain, diarrhea, or hematochezia.10 Our HRFQ, a validated screening tool, considers mucus bloody stools, chronic diarrhea, and chronic constipation as intermittent history over time. Although these three symptoms were present as a past history, we collectively agreed to remove the term “asymptomatic” from the manuscript description considering other articles on screening. We also evaluated the risk factors documented in the HRFQ. We found that a history of chronic constipation,

目的 挖掘大肠癌手术治疗患者高额住院费用出现的预警信息,为减轻大肠癌手术治疗患者经济负担提供依据和对策.方法 收集2018-2020年某医院大肠癌患者的住院信息,利用Apriori算法挖掘各因素与高额住院费用之间潜在的强关联规则.结果 共纳入305例患者,患者手术治疗次住院费用的中位数为83591元(IQR=22877元),P75为97776元.多元线性回归分析结果显示大肠癌患者住院费用的相关因素包括:住院天数、其他伴随手术数量、疾病发现途径、病理分期、分化程度、延迟就诊时间6项因素(P<0.05).Apriori算法挖掘出的14条与高额住院费用相关的强规则中,9条与住院天数相关,7条与病理分期、疾病发现途径相关.满足强关联规则的患者出现高额费用的概率均是全部患者的3倍以上.结论 大肠癌手术治疗患者高额住院费用的主要预警信息包括:住院天数≥30天、病理分期为D期、因症就诊.通过规范临床路径、建立住院天数监控反馈机制、优化住院患者诊疗流程、开展大肠癌健康教育和人群筛查或有利于控制高额住院费用的产生.

[目的]分析2012-2022年天津市结直肠癌筛查结果.[方法]采用结直肠癌问卷风险评估和免疫法便潜血试验(FIT)相结合的方法筛查出目标人群中的结直肠癌高危人群,对其行全结肠镜检查.[结果]2012-2022年天津市结直肠癌筛查项目累计完成结直肠癌风险评估问卷调查7 126 853份,FIT检测5 570 502份.其中发现高危人群319 035人(占比4.48％),早诊率达到86.27％.另外,全结肠镜检出腺瘤72 962例、进展期腺瘤15 097例,锯齿状腺瘤1 736例、其他伴上皮高级别瘤变632例、早期癌1 109例、中晚期癌2 955例.[结论]社区人群中开展结直肠癌筛查工作,普及结直肠癌防治知识,提高居民筛查知晓率,可使结直肠癌疾病负担得到有效控制.

OBJECTIVE:This study seeks to assess the efficacy of exfoliated colonocytes isolated from feces (ECIF) miR-92a as a clinical colorectal cancer diagnostic marker in a larger cohort.METHODS:Clinicopathologic data from colorectal cancer patients and health controls that underwent colonoscopy, as well as patients of other cancers diagnosed, were included. A total of 963 Chinese participants were enrolled, with 292 (27.4%) having colorectal cancer, 140 (14.5%) having other types of cancer, e.g., pancreatic, liver, oral, bile duct, esophagus, and stomach cancer, 171 (17.8%) having infection in the intestine, rectal, stomach, appendix, and gastrointestinal ulcer, and 360 (37.4%) of healthy controls. ECIF samples were gathered and miR-92a levels were detected using TaqMan probe-based miR-92a real-time quantitative PCR (RT-qPCR) kit developed by Shenzhen GeneBioHealth Co., Ltd.RESULTS:Through a series of experiments, we demonstrated that the Ep-LMB/Vi-LMB magnetic separation system is feasible, highly specific, and highly sensitive at a cutoff value of 1053 copies per 6 ng of ECIF RNA. ECIF miR-92a levels were significantly higher in colorectal cancer patients than in controls. Colorectal cancer detection sensitivity and specificity were 87.3% and 86.9% respectively. Furthermore, the performance of this miR-92a detection kit demonstrated that it is an effective tool for colorectal cancer, with a high sensitivity of 84.1%, even in early cancer stages (0, I, and II). Furthermore, tumor removal resulted in lower stool miR-92a levels (3.21±0.58 vs. 2.14±1.14, P < 0.0001, n = 65).CONCLUSION:Finally, the miR-92a RT-qPCR kit detects ECIF-increased miR-92a and could be used for colorectal cancer screening.

Abstract Introduction Geriatric assessment (GA) is widely used to detect vulnerability in older patients. As this process is time-consuming, prescreening tools have been developed to identify patients at risk for frailty. We aimed to assess whether the Geriatric 8 (G8) or the Korean Cancer Study Group Geriatric Score (KG-7) shows better performance in identifying patients who are in need of full GA. Materials and methods A consecutive series of patients aged ≥ 60 years with colorectal cancer were included. The sensitivity, specificity, predictive value, and 95% confidence intervals (95% CI) were calculated for the G8 and the KG-7 using the results of GA as the reference standard. ROC(Receiver Operating Characteristic) was used to evaluate the accuracy of the G8 and the KG-7. Results One hundred four patients were enrolled. A total of 40.4% of patients were frail according to GA, and 42.3% and 50.0% of patients were frail based on the G8 and the KG-7, respectively. The sensitivity and specificity of the G8 were 90.5% (95% CI: 77.4–97.3%) and 90.3% (95% CI: 80.1–96.4%), respectively. For the KG-7, the sensitivity and specificity were 83.3% (95% CI: 68.6–93.0%) and 72.6% (95% CI: 59.8–83.1%), respectively. Compared to the KG-7, the G8 had a higher predictive accuracy (AUC: (95% CI): 0.90 (0.83–0.95) vs. 0.78 (0.69–0.85); p < 0.01). By applying the G8 and the KG-7, 60 and 52 patients would not need a GA assessment, respectively. Conclusion Both the G8 and the KG-7 showed a great ability to detect frailty in older patients with colorectal cancer. In this population, compared to the KG-7, the G8 had a better performance in identifying those in need of a full Geriatric Assessment.

The incidence of bone metastasis (BM) in colorectal cancer (CRC) patients is low and the prognosis is poor. There is no clear conclusion on the risk factors affecting the survival of CRC patients with BM. The aim of this study was to investigate the factors that may affect the prognosis of CRC patients with BM. The clinical and pathological data of CRC patients with BM were retrospectively analyzed. The overall survival after BM diagnosis was estimated using the Kaplan–Meier method and Log-rank test, and a multivariable cox regression model was used to identify the prognostic factors of overall survival. This study included 178 CRC patients with BM, of whom 151 had left-sided CRC and 27 had right-sided colon cancer. 1124 CRC patients with BM from the SEER database were included to perform a sensitivity analysis of the primary outcome. Multivariate analysis showed that the N staging, site of BM, and primary tumor sidedness (PTS) were independent prognostic factors for CRC with BM. Among them, right-sided colon cancer patients with BM had a poorer prognosis. Sensitivity analyses showed that PTS was an independent prognostic factor in CRC patients with BM. Primary tumor sidedness and N stage may be potential prognostic markers for BM of CRC. The prognosis of N0 stage CRC with BM is better, while the prognosis of right-sided colon cancer is poor.

AimTransanal endoscopic microsurgery (TEM) is widely performed in early rectal cancer. This technique offers greater organ preservation and decreases the risk of subsequent surgery. However, postoperative local recurrence and distant metastasis remain challenges for patients with high-risk pathological factors. This single-center study reports the prognosis of early rectal cancer patients over 60 years old after TEM.MethodsThe data of the patients over 60 years old who underwent local anal resection were collected retrospectively. Moreover, the 5-year follow-up data were analyzed to determine the 5-year DFS and OS.Results47 early rectal cancer patients over 60 years old underwent TEM. There were 27 patients with high-risk factors and 20 patients without high-risk factors. Two patients underwent radical surgery after TEM and ten patients received adjuvant treatment. Local recurrence occurred in 7 patients, of which 4 underwent salvage surgery. The 5-year progression-free survival rate was 75.6%, which was lower in the high-risk patients group (69.6%) than in the non-high-risk patients group (83.3%) (P>0.05). The 5-year OS was 90.2%, but there was no statistically significant difference between the two groups (high-risk patients 87.0%, non-high-risk patients 94.4%). Furthermore, there was no significant difference in DFS and OS between people over and under 70 years old.ConclusionSome high-risk factor patients over 60 years old do not have inferior 5-year DFS and OS to the non-high-risk patients. TEM is an option for old patients with high surgical risks. Even if postoperative pathology revealed high-risk factors, timely surgical treatment after local recurrence would be beneficial to improve the 5-year DFS and OS.

BackgroundThe recent uptrend in colorectal cancer (CRC) incidence in China is causing an increasingly overwhelming social burden. And its occurrence can be effectively reduced by sensitizing CRC screening for early diagnosis and treatment. However, a large number of people in China do not undergo screening due to multiple factors. To address this issue, since 2012, a CRC screening program has been initiated in Tianjin. MethodsResidents aged 40-74 years were eligible for CRC screening. The first was to complete the high-risk factor questionnaire (HRFQ) and undergo fecal immunochemical test (FIT). Then those with a positive result in any of the two screening methods were recommended for a free colonoscopy. ResultsThe detection rate of intestinal diseases increased with age, had a male predominance, and was higher in residents from central urban areas and those with primary school above education level. The sensitivity of predicting CRC after colonoscopy in the high-risk group was 76.02%; the specificity was 25.33%.A significant decrease in the detection rate of intestinal disease, CRC and advanced adenoma was observed from positive FIT, the high-risk group and positive HRFQ, 47.13%, 44.79%, 42.30%; 3.15%, 2.44%, 1.76%; 7.72%, 6.42%, 5.08%, in that order, while no inter-group difference was found for the detection of polyps. In addition, the different combinations of HRFQ and FIT can enroll more high-risk population than FIT or (and) HRFQ only, and thus detect more intestinal diseases (include CRC/AA/Polyp). ConclusionThe superimposition of different screening method for HRFQ and FIT is an effective strategy for the detection of CRC, AA, and Polyp, compared to HRFQ or FIT alone. However, further improvements in screening and interventions are needed to promote colonoscopy compliance.

AimTransanal endoscopic microsurgery (TEM) is widely performed in early rectal cancer. This technique offers greater organ preservation and decreases the risk of subsequent surgery. However, postoperative local recurrence and distant metastasis remain challenges for patients with high-risk pathological factors. This single-center study reports the prognosis of early rectal cancer patients over 60 years old after TEM. MethodsThe data of the patients over 60 years old who underwent local anal resection were collected retrospectively. Moreover, the 5-year follow-up data were analyzed to determine the 5-year DFS and OS. Results47 early rectal cancer patients over 60 years old underwent TEM. There were 27 patients with high-risk factors and 20 patients without high-risk factors. Two patients underwent radical surgery after TEM and ten patients received adjuvant treatment. Local recurrence occurred in 7 patients, of which 4 underwent salvage surgery. The 5-year progression-free survival rate was 75.6%, which was lower in the high-risk patients group (69.6%) than in the non-high-risk patients group (83.3%) (P>0.05). The 5-year OS was 90.2%, but there was no statistically significant difference between the two groups (high-risk patients 87.0%, non-high-risk patients 94.4%). Furthermore, there was no significant difference in DFS and OS between people over and under 70 years old. ConclusionSome high-risk factor patients over 60 years old do not have inferior 5-year DFS and OS to the non-high-risk patients. TEM is an option for old patients with high surgical risks. Even if postoperative pathology revealed high-risk factors, timely surgical treatment after local recurrence would be beneficial to improve the 5-year DFS and OS.

目的 了解大肠癌初筛阳性居民肠镜复筛行为与健康信念各维度的关系,为提高肠镜顺应性提供可行性建议.方法 采取病例对照研究,从天津市人民医院获取2019年6—11月大肠癌初筛阳性后接受肠镜检查的316人纳入接受肠镜组,采用整群随机抽样抽取154例未接受肠镜检查的居民纳入拒绝肠镜组.应用Logistic回归分析健康信念与肠镜复筛行为的关系.结果 拒绝肠镜组严重性认知的平均得分为(12.58±2.36)分,低于接受肠镜组得分(13.28±1.90)分;拒绝肠镜组行为障碍认知的平均得分为(15.93±3.68)分,高于接受肠镜组得分(14.71±3.95)分.调整年龄以及工作种类后,严重性认知水平为大肠癌高危人群肠镜检查的保护因素(OR=1.136,95％CI:1.010-1.276),行为障碍认知水平为肠镜检查的危险因素(OR=0.926,95％CI:0.873-0.982).结论 在大肠癌初筛对象的健康教育中强化对疾病严重性的宣传,做好复筛意义和流程的介绍,可提高肠镜复筛的依从性.

Abstract Background: Colorectal cancer (CRC) is a common malignant tumor, it is necessary to conduct in-depth research on the pathogenesis, early diagnosis, and prognosis evaluation. The assessment of postoperative prognosis is beneficial to the accurate treatment for patients. Metabolomics can explore the metabolic changes in the process of cancer, to find new markers that can be used for early diagnosis of cancer and evaluation of efficacy. Method: In this study, ultra-high-performance liquid chromatography quarter time of fly mass spectrometer (UPLC-Q-TOF-MS) technology was used to screen the metabolomics markers of blood samples from 24 CRC patients who underwent surgery and 24 healthy people. To verify the potential markers found above, At the same time, 8 CRC patients and normal control group were included. Results: UDP-D-galactose, which shown significant concentration changed 2 ~ 3 days after surgery was screened after statistical analysis. Moreover, the analysis of metabolic pathways in tissue samples also fully verified the correlation between UDP-D-galactose and CRC. Conclusion: UPLC-Q-TOF-MS is a practical method for screening metabolic markers. Accurate monitoring the concentration of UDP-D-galactose in blood can provide important assistance for the treatment of CRC patients.

目的:了解天津市基层医疗卫生机构结直肠癌、乳腺癌、宫颈癌筛查开展情况,探讨基层医疗卫生机构开展肿瘤筛查工作中存在的问题和原因.方法:于2017年12月—2018年5月问卷调查天津市全部基层医疗机构,共262家,回收有效问卷242份;调查负责3种肿瘤筛查的基层医务人员554人.结果:乡镇卫生院比社区卫生服务中心完成3种肿瘤筛查任务的比例高.社区卫生服务中心认为完成3种肿瘤筛查任务存在困难的机构比例高于乡镇卫生院.结论:天津市基层医疗卫生机构完成结直肠癌筛查项目任务完成情况较好;相较于社区卫生服务中心,乡镇卫生院肿瘤筛查完成情况较好;提高居民参与率,合理配置肿瘤筛查人力和设备资源,将有利于基层医疗机构肿瘤筛查工作的开展.

Background A colorectal cancer screening programme (CCSP) was implemented from 2012 to 2017 in Tianjin, China. Residents with a positive faecal immunochemical test (FIT) or positive self-reported symptom questionnaire (SRSQ) were recommended to undergo colonoscopy. The objective was to investigate the potential factors associated with nonadherence to colonoscopy among a risk-increased population. Methods Data were obtained from the CCSP database, and 199,522 residents with positive FIT or positive SRSQ during two screening rounds (2012–2017) were included in the analysis. Logistic regression analysis was performed to assess the association between nonadherence to colonoscopy and potential predictors. Results A total of 152,870 (76.6%) individuals did not undergo colonoscopy after positive FIT or positive SRSQ. Residents with positive SRSQ but without positive FIT were more likely not to undergo colonoscopy (negative FIT: OR, 2.35; 95% CI, 2.29–2.41, no FIT: OR, 1.27; 95% CI, 1.24–1.31). Patients without a cancer history were less likely to undergo colonoscopy even if they received risk-increased reports based on the SRSQ. Conclusion In the CCSP, seventy-seven percent of the risk-increased population did not undergo colonoscopy. FIT should be recommended since positive FIT results are related to improved adherence to colonoscopy. Residents with negative FIT but positive SRSQ should be informed of the potential cancer risk to ensure adherence to colonoscopy.