Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre, Heidelberg, Germany.
Br J Cancer. 2012 Apr 10;106(8):1424-30. doi: 10.1038/bjc.2012.104. Epub 2012 Mar 27.
Faecal occult blood tests (FOBTs) are widely used for colorectal cancer (CRC) screening. Blood-based inflammatory markers have been suggested as alternative or supplementary non-invasive CRC screening tests.
Among 179 CRC patients, 193 people with advanced adenoma and 225 people free of neoplasm, C-reactive protein (CRP), serum CD26 (sCD26), complement C3a anaphylatoxin and tissue inhibitor of metalloproteinases 1 (TIMP-1) levels in blood were measured by ELISA tests, and an immunochemical FOBT (iFOBT) and a guaiac-based FOBT were performed. Receiver operating characteristic curves were constructed and the areas under the curves (AUCs) were compared.
The blood levels of CRP, sCD26 and TIMP-1 showed statistically significant differences between CRC patients and neoplasm-free participants, and levels of TIMP-1 were furthermore significantly elevated in advanced adenoma patients. For the four inflammatory markers, AUCs ranged from 0.52 to 0.62 for CRC detection and from 0.50 to 0.58 for advanced adenomas detection, compared with AUCs of 0.90 and 0.68 for the iFOBT. At 97% specificity, blood markers showed much lower sensitivities than FOBTs. Combining inflammatory markers with the iFOBT increased the AUC for advanced adenomas.
These blood-based markers do not seem to be an alternative to FOBT-based CRC screening. The potential use of these and other blood-based tests in combination with iFOBT might deserve further attention.
粪便潜血检测（FOBT）被广泛应用于结直肠癌（CRC）的筛查。血液炎症标志物已被提议作为替代或补充的非侵入性 CRC 筛查检测方法。
在 179 名 CRC 患者、193 名高级别腺瘤患者和 225 名无肿瘤患者中，通过 ELISA 检测了血液中的 C 反应蛋白（CRP）、血清 CD26（sCD26）、补体 C3a 过敏毒素和组织金属蛋白酶抑制剂 1（TIMP-1）水平，并进行了免疫化学 FOBT（iFOBT）和愈创木脂 FOBT。构建了受试者工作特征曲线，并比较了曲线下面积（AUC）。
CRC 患者与无肿瘤参与者的血液 CRP、sCD26 和 TIMP-1 水平存在统计学显著差异，且高级别腺瘤患者的 TIMP-1 水平进一步升高。对于这四个炎症标志物，CRC 检测的 AUC 范围为 0.52 至 0.62，高级别腺瘤检测的 AUC 范围为 0.50 至 0.58，而 iFOBT 的 AUC 为 0.90 和 0.68。在特异性为 97%时，血液标志物的敏感性远低于 FOBT。将炎症标志物与 iFOBT 相结合，可提高对高级别腺瘤的 AUC。
这些血液标志物似乎不能替代基于 FOBT 的 CRC 筛查。这些和其他血液检测方法与 iFOBT 联合应用的潜力值得进一步关注。
