Fecal Hemoglobin Levels in Prior Negative Screening and Detection of Colorectal Neoplasia: A Dose-Response Meta-Analysis.

Understanding the dose-response association between f-Hb in a prior screening round and the detection of colorectal neoplasia is crucial for tailoring risk-based screening recommendations.

了解先前筛查轮次中粪便血红蛋白（f-Hb）与结直肠肿瘤检测之间的剂量反应关系对于制定基于风险的筛查建议至关重要。

Methods

We searched the literature to identify studies reporting the association between f-Hb in prior screening round and colorectal neoplasia detection in an average-risk population.

我们检索了文献，以确定报告先前筛查轮次中粪便潜血（f-Hb）与平均风险人群结直肠肿瘤检测之间关联的研究。

Analysis involved a 2-stage approach using log-log regression models to assess dose-response relationships across studies, with effect sizes pooled using a random effects model.

分析采用了两阶段方法，使用对数-对数回归模型来评估各研究之间的剂量-反应关系，并使用随机效应模型汇总效应量。

Heterogeneity was assessed by excluding individual studies in sensitivity analyses.

通过敏感性分析排除个别研究来评估异质性。

Subgroup analyses examined variations in effects by outcome definitions and detection methods.

亚组分析检查了通过结果定义和检测方法的变化对效果的影响。

Results

This systematic reviewand meta-analysisincluded 13 studies with 4,493,672 individuals.

本系统评价和荟萃分析纳入了13项研究，共涉及4,493,672名个体。

All studies demonstrated a positive association between f-Hb in prior screenings and colorectal neoplasia detection.

所有研究均显示，既往筛查中的粪便潜血（f-Hb）与结直肠肿瘤检测之间存在正相关关系。

Pooled analysis revealed that individuals with f-Hb concentrations of 5, 10, 20, and 40 μg/g had a 3-, 5-, 8-, and 13-fold higher risk of colorectal neoplasia, respectively, compared with individuals with 0 μg/g.

汇总分析显示，与0 μg/g的个体相比，f-Hb浓度为5, 10, 20, 和40 μg/g的个体患结直肠肿瘤的风险分别高出3倍、5倍、8倍和13倍。

Although significant heterogeneity (I2 = 97.5%, P < .001) was observed, sensitivity analyses confirmed the consistency of findings.

尽管观察到显著的异质性（I2 = 97.5%，P < .001），但敏感性分析证实了研究结果的一致性。

Subgroup analyses indicated that f-Hb concentrations from previous negative tests were especially predictive of advanced neoplasia in subsequent screenings.

亚组分析表明，先前阴性测试中的f-Hb浓度特别能够预测随后筛查中的高级别肿瘤。

Conclusions

Our findings suggest that the risk of detecting colorectal neoplasia increases with prior f-Hb concentrations in negative tests, supporting the development of risk-stratified screening strategies based on these concentrations.

我们的发现表明，随着先前阴性测试中的f-Hb浓度增加，检测结直肠肿瘤的风险也随之增加，这支持基于这些浓度开发分层风险筛查策略。