Istituto Scientifico Romagnolo per lo Studio e Cura dei Tumori, Via Piero Maroncelli 40, 47014 Meldola (FC), Italy.
Cancer Epidemiol Biomarkers Prev. 2010 Oct;19(10):2647-54. doi: 10.1158/1055-9965.EPI-10-0291.
We aimed to define the potential of the fecal DNA assay as an alternative or in addition to the currently used immunochemical fecal occult blood test (iFOBT) for the early diagnosis of colorectal cancer.
A total of 560 individuals aged 50 to 69 years with a positive iFOBT were recruited from an Italian FOBT regional screening program. Twenty-six were diagnosed with adenocarcinoma, 264 with high-risk adenoma, and 54 with low-risk adenoma, whereas 216 subjects did not have premalignant or malignant lesions. Fecal DNA integrity was analyzed blindly by the fluorescence long DNA (FL-DNA) test.
iFOBT and FL-DNA were largely independent variables (rs = 0.036, P = 0.42), with values ranging from 101 to 5,826 ng/mL and from 0 to 515 ng, respectively. Median values of both variables were significantly higher in cancer patients than in patients with noncancerous lesions or in healthy individuals. Moreover, iFOBT and FL-DNA values were individually associated with a number of pathologic parameters. Sequential use of the diagnostic iFOBT and FL-DNA methods showed that fecal DNA provided more accurate diagnostic information and was able to identify subgroups at different risk of cancer in iFOBT-positive individuals.
A combined approach based on FL-DNA and iFOBT evaluation could help to better identify colorectal cancers and to determine a patient's risk of harboring a preneoplastic or neoplastic lesion. Further evaluation in a screening setting is needed to confirm this hypothesis.
Fecal DNA could be a useful tool to better predict cancer risk in FOBT-positive individuals.
我们旨在确定粪便 DNA 检测作为目前使用的免疫化学粪便潜血试验（iFOBT）的替代或补充方法，用于结直肠癌的早期诊断。
我们从意大利的一项 FOBT 区域筛查计划中招募了 560 名年龄在 50 至 69 岁之间、iFOBT 阳性的个体。其中 26 人被诊断为腺癌，264 人患有高危腺瘤，54 人患有低危腺瘤，而 216 人没有癌前或恶性病变。粪便 DNA 完整性通过荧光长 DNA（FL-DNA）检测进行盲法分析。
iFOBT 和 FL-DNA 是两个相互独立的变量（rs = 0.036，P = 0.42），其值范围分别为 101 至 5826ng/mL 和 0 至 515ng。癌症患者的两种变量的中位数均显著高于无癌病变患者或健康个体。此外，iFOBT 和 FL-DNA 值与多个病理参数相关。单独使用诊断性 iFOBT 和 FL-DNA 方法显示，粪便 DNA 提供了更准确的诊断信息，并能够识别 iFOBT 阳性个体中不同癌症风险的亚组。
基于 FL-DNA 和 iFOBT 评估的联合方法可帮助更好地识别结直肠癌，并确定患者是否存在癌前或肿瘤病变的风险。在筛查环境中进一步评估以验证该假设是必要的。
粪便 DNA 可能是一种有用的工具，可更好地预测 FOBT 阳性个体的癌症风险。
