Fecal Immunochemical Test Screening Status, Stage Distribution, and Overall Survival in Colorectal Cancer: A Propensity Score-Matched Cohort Study from a Regional Hospital in Taiwan

Background/Objectives: Fecal immunochemical testing (FIT)-based screening for colorectal cancer (CRC) has been associated with reductions in CRC mortality and improvements in early-stage disease detection; however, most related evidence has been derived from large national registries. The present study investigated associations of FIT screening status with overall survival (OS) and several clinicopathological characteristics in a regional hospital setting. Methods: After propensity score matching, 912 patients with pathologically confirmed colorectal adenocarcinoma diagnosed between 2010 and 2025 at a regional hospital in Taiwan were included. Patients were categorized into screened (n = 304) and nonscreened (n = 608) groups by using propensity score matching based on age as a continuous variable, sex, and stage. OS and clinicopathological characteristics in each group were compared. Multivariable Cox regression was performed using a primary reduced model, an exploratory full model, and multiple imputation analysis. Results: Screened patients demonstrated better 15-year OS (58.38% vs. 45.80%; log-rank p = 0.005), especially those with early-stage disease (p = 0.001). FIT screening was independently associated with improved OS in the primary reduced model (hazard ratio [HR] = 0.63; 95% confidence interval [CI]: 0.45–0.88; p = 0.006) and multiple imputation analysis (HR = 0.68; 95% CI: 0.50–0.91; p = 0.010). Independent adverse prognostic factors were male sex, late-stage disease, perineural invasion, tumor obstruction, and abnormal pretreatment carcinoembryonic antigen level. Conclusions: FIT screening was associated with better long-term OS in a stage-balanced cohort, but interpretation is limited by the use of OS rather than CRC-specific survival and residual age imbalance. Improving FIT participation, timely colonoscopy follow-up, and complete pathological staging remains essential for CRC outcomes.