Ouyang Daniel L, Chen Joseph J, Getzenberg Robert H, Schoen Robert E
Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Am J Gastroenterol. 2005 Jun;100(6):1393-403. doi: 10.1111/j.1572-0241.2005.41427.x.
Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States. Endoscopic screening is now in favor and its use is increasing, but overall participation rates are poor. A substantial percentage of the population will likely continue to resist endoscopic screening. As such, a noninvasive biomarker for the early detection of CRC remains a priority. Herein, we (i) review the currently available noninvasive screening markers for the early detection of CRC, (ii) discuss newer markers that have undergone preliminary testing, and (iii) introduce and explain potentially promising markers of the future.
The published literature on markers for early detection of CRC was identified using a MEDLINE/PubMed search with secondary review of cited publications.
Noninvasive testing for CRC is most advanced in testing for stool fecal occult blood, globin, or DNA mutations. Study of abnormal mucins has also been explored. Research for serum-based markers is just beginning and includes serum proteomics, nuclear matrix proteins, and serum DNA testing.
Serial guaiac-based fecal occult blood testing (FOBT) is simple, inexpensive, and proven effective at reducing mortality from CRC. Immunochemical fecal occult blood tests facilitate compliance and offer improved specificity, but at increased cost in comparison to FOBT. Fecal DNA testing may provide enhanced sensitivity for detection of CRC in comparison with FOBT, but its high cost limits its use for generalized screening. Rectal mucin testing requires additional evaluation to determine its sensitivity and specificity in comparison with guaiac-based FOBT. Serum tests, such as proteomics, nuclear matrix proteins, and serum DNA, are still in their infancy, but remain a hope for the future.
结直肠癌（CRC）是美国癌症相关死亡的第二大主要原因。内镜筛查目前受到青睐且使用正在增加，但总体参与率较低。相当一部分人群可能会继续抵制内镜筛查。因此，用于CRC早期检测的非侵入性生物标志物仍然是一个优先事项。在此，我们（i）回顾目前可用于CRC早期检测的非侵入性筛查标志物，（ii）讨论已进行初步测试的新标志物，以及（iii）介绍并解释未来可能有前景的标志物。
使用MEDLINE/PubMed搜索确定关于CRC早期检测标志物的已发表文献，并对引用的出版物进行二次审查。
CRC的非侵入性检测在粪便潜血、珠蛋白或DNA突变检测方面最为先进。对异常粘蛋白的研究也已展开。基于血清的标志物研究刚刚起步，包括血清蛋白质组学、核基质蛋白和血清DNA检测。
基于愈创木脂的连续粪便潜血检测（FOBT）简单、廉价，且已被证明可有效降低CRC死亡率。免疫化学粪便潜血检测便于患者依从且特异性有所提高，但与FOBT相比成本增加。与FOBT相比，粪便DNA检测可能对CRC检测具有更高的灵敏度，但其高成本限制了其在广泛筛查中的应用。与基于愈创木脂的FOBT相比，直肠粘蛋白检测需要进一步评估以确定其灵敏度和特异性。血清检测，如蛋白质组学、核基质蛋白和血清DNA检测，仍处于起步阶段，但仍是未来的希望。
