China Colorectal Cancer Screening Trial 2 (C-Cost2)

NCT07090304 | Not Yet Recruiting

• 1 other identifier: C-Cost2
• Study Type: interventional
• Target: 7,504
• Locations: 0 countries
• Sites: N/A

Brief Summary

Colorectal cancer (CRC) is one of the most common malignancies in China. Currently, its incidence rate is increasing at a rate of 4% per year, exceeding the global annual average growth rate. Screening and early diagnosis of colorectal cancer and precancerous lesions are key measures to reduce the disease burden of colorectal cancer in China. In previous clinical studies, colorectal cancer screening in high risk population received extensive attention. However, it cannot be ignored that the majority of sporadic colorectal cancers occur in the average risk population. Therefore, there is an urgent need to develop new approach for colorectal cancer screening in the average risk population in China. Fecal Immunochemical Testing (FIT) initial screening followed by diagnostic colonoscopy is widely recommended by colorectal cancer screening guidelines worldwide. The current colorectal cancer screening approach faces challenges including limited sensitivity of initial screening technologies and insufficient population coverage in organized screening programs in China. Stool DNA tests detect DNA biomarkers of tumor cells in the stool and have higher sensitivity in detecting advanced colorectal neoplasms. USPSTF has recommended FIT-sDNA as initial screening tests in the average risk population. Colorectal Cancer Early Screening in China (Clear-C) trial has reported FIT-sDNA had higher sensitivity than FIT in detecting advanced colorectal neoplasms among high risk population, yet there is a lack of randomized controlled trials (RCTs) directly comparing the effectiveness of FIT and FIT-sDNA for colorectal cancer screening in the average risk population in China. In China Colorectal Cancer Screening Trial 2 (C-Cost2), we propose to perform a multicenter, individual-level randomized, parallel group trial directly comparing FIT and FIT-sDNA in the average risk population in China. The main research hypothesis is that the screening protocol of FIT-sDNA group (Group B) has a superior detection rate of advanced colorectal neoplasms compared to the FIT group (Group A).

Conditions

Colorectal Cancer; Advanced Adenoma

Keywords

FIT; FIT-sDNA; Colorectal cancer; Advanced colorectal adenoma; Early screening; Average risk population

Outcome Measures

Primary Outcomes (1)

• Detection rate of advanced colorectal neoplasms

  Advanced colorectal neoplasms includes advanced adenomas and colorectal cancer

  4 years

Secondary Outcomes (7)

• Population compliance rate

  4 years

• Proportion of colorectal cancer at different stages

  4 years

• Incidence rate of colorectal cancer

  10 years

• Mortality rate of colorectal cancer

  10 years

• Quality of life (QOL)

  4 years

Study Arms (2)

FIT group

ACTIVE COMPARATOR

The internationally recommended screening protocol is adopted. In the first 4 years of the screening phase, all participants will receive annual FIT tests. Participants with positive FIT results are recommended to undergo diagnostic colonoscopy. Suspicious lesions detected during the colonoscopy will be resected and further sent for pathological examination. Participants who refuse FIT tests, have negative FIT tests, have positive FIT tests but do not receive diagnostic colonoscopy will be screened again in the first 4 years. All the participants will be followed by long-term follow-ups.

Diagnostic Test: FIT

FIT-sDNA group

EXPERIMENTAL

A new screening protocol is adopted. In the first 4 years of the screening phase, all participants will receive annual FIT-sDNA tests. Participants with positive FIT-sDNA results are recommended to undergo diagnostic colonoscopy. Suspicious lesions detected during the colonoscopy will be resected and further sent for pathological examination. Participants who refuse FIT-sDNA tests, have negative FIT-sDNA tests, have positive FIT-sDNA tests but do not receive diagnostic colonoscopy will be screened again in the first 4 years. All the participants will be followed by long-term follow-ups.

Diagnostic Test: FIT-sDNA

Interventions

FIT DIAGNOSTIC_TEST

FIT stands for Fecal Immunochemical Test, a non-invasive screening tool used primarily to detect hidden blood in the stool, which may indicate colorectal cancer or precancerous polyps. Positive cut-off level: 100 ng/mL.

FIT group

FIT-sDNA DIAGNOSTIC_TEST

FIT-sDNA test combines Fecal Immunochemical Test (FIT) and stool DNA (sDNA) analysis. It detects hemoglobin in stool through FIT to identify occult blood in the gastrointestinal tract and simultaneously analyzes specific DNA mutations or epigenetic alterations (such as methylation changes) in stool DNA to assess the risk of colorectal neoplasms.

FIT-sDNA group

Eligibility Criteria

• Age: 45 Years - 74 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age: 45-74 years old;
• In good general condition, with normal mental state and voluntarily signing the informed consent form;

You may not qualify if:

• Personal history of colorectal cancer or precancerous lesions;
• History of previous colonrectal resection surgery;
• Diagnosed with cancer before enrollment or currently receiving any cancer-related treatment;
• Having received colonoscopy, flexible sigmoidoscopy, CT colonography and other examinations within the past 5 years;
• Having received FIT or FIT-sDNA or cfDNA test within the past 1 year;
• Symptomatic lower gastrointestinal diseases or symptoms suggesting the need for diagnostic colonoscopy for confirmation;
• Accompanied by severe diseases that are not suitable for colorectal cancer screening;

Sponsors & Collaborators

• Zhejiang University: lead

MeSH Terms

Conditions

Colorectal Neoplasms

Condition Hierarchy (Ancestors)

Intestinal Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Rectal Diseases

Central Study Contacts

Kefeng Ding

CONTACT

86-571-87784827; dingkefeng@zju.edu.cn

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SCREENING
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: July 20, 2025
• First Posted: July 29, 2025
• Study Start: July 1, 2025
• Primary Completion (Estimated): November 1, 2028
• Study Completion (Estimated): November 1, 2028
• Last Updated: July 29, 2025

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share