Fecal hemoglobin concentration as a risk stratification tool for advanced colorectal neoplasm in a community-based...

Compared with traditional binary classification, the quantitative fecal immunochemical test (qFIT) provides detailed fecal hemoglobin (f-Hb) concentrations, which facilitate more refined risk stratification for advanced colorectal neoplasm; however, this approach remains underexplore.

Based on the Shanghai colorectal cancer (CRC) screening program, 7,097 residents were enrolled. Participants who completed both qFIT and colonoscopy were included in the analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) derived from logistic regression models were used to evaluate the association between f-Hb concentration and the risk of advanced neoplasm. Subgroup analyses by age and sex were conducted for further risk stratification.

The median f-Hb concentration was significantly higher in participants with advanced neoplasm (71 ng/mL; interquartile range[IQR]: 20-412 ng/mL) compared with those without neoplasm (19 ng/mL; IQR: 11-41.5 ng/mL) (P<0.001). The proportion of advanced neoplasm increased with rising f-Hb concentration. Logistic regression analysis revealed that, compared with participants with f-Hb <50 ng/mL, 2.91-fold, 3.92-fold, and 24.21-fold increased risks of advanced neoplasm were observed for those with f-Hb of 50-99 ng/mL, 100-799 ng/mL, and ≥800 ng/mL, respectively. According to sex, age, and f-Hb concentration, 16 categories were identified. Risk stratification was based on ORs as follows: reference, normal risk; 1 to <3, low risk; 3 to <10, moderate risk; and ≥10, high risk. Using this criterion, 674 (71.25%), 138 (14.59%), 103 (10.89%), and 31 (3.28%) participants were classified into the normal-, low-, moderate-, and high-risk groups, respectively.

F-Hb concentration is predictive of the severity of colorectal neoplasm and may be used for risk stratification of advanced neoplasm.