血液 RNA 生物标志物 panel 可检测左、右侧结直肠肿瘤：一项病例对照研究。
Blood RNA biomarker panel detects both left- and right-sided colorectal neoplasms: a case-control study.
机构信息
GeneNews Ltd, 2 East Beaver Creek Road, Building 2, Richmond Hill, Ontario, Canada.
出版信息
J Exp Clin Cancer Res. 2013 Jul 23;32(1):44. doi: 10.1186/1756-9966-32-44.
BACKGROUND
Colonoscopy is widely regarded to be the gold standard for colorectal cancer (CRC) detection. Recent studies, however, suggest that the effectiveness of colonoscopy is mostly confined to tumors on the left side of the colon (descending, sigmoid, rectum), and that the technology has poor tumor detection for right-sided (cecum, ascending, transverse) lesions. A minimally invasive test that can detect both left-sided and right-sided lesions could increase the effectiveness of screening colonoscopy by revealing the potential presence of neoplasms in the right-sided "blind spot".
METHODS
We previously reported on a seven-gene, blood-based biomarker panel that effectively stratifies a patient's risk of having CRC. For the current study, we assessed the effectiveness of the seven-gene panel for the detection of left- and right-sided CRC lesions. Results were evaluated for 314 patients with CRC (left-sided: TNM I, 65; TNM II, 57; TNM III, 60; TNM IV, 17; unknown, 9. right-sided: TNM I, 28; TNM II, 29; TNM III, 38; TNM IV, 12; unknown, 1 and including two samples with both left and right lesions) and 328 control samples. Blood samples were obtained prior to clinical staging and therapy. Most CRC subjects had localized disease (stages I and II, 58%); regional (stage III) and systemic (stage IV) disease represented 32% and 9%, respectively, of the study population.
RESULTS
The panel detected left-sided (74%, 154/208) and right-sided (85%, 92/108) lesions with an overall sensitivity of 78% (215/316) at a specificity of 66% (215/328). Treatable cancer (stages I to III) was detected with left-sided lesion sensitivity of 76% (138/182) and right-sided sensitivity of 84% (80/95).
CONCLUSION
This seven-gene biomarker panel detected right-sided CRC lesions across all cancer stages with a sensitivity that is at least equal to that for left-sided lesions. This study supports the use of this panel as the basis for a patient-friendly, blood-based test that can be easily incorporated into a routine physical examination in advance of colonoscopy to provide a convenient companion diagnostic and a pre-screening alert, ultimately leading to enhanced CRC screening effectiveness.
背景
结肠镜检查被广泛认为是结直肠癌（CRC）检测的金标准。然而，最近的研究表明，结肠镜检查的有效性主要局限于结肠左侧（降结肠、乙状结肠、直肠）的肿瘤，对于右侧（盲肠、升结肠、横结肠）病变，该技术的肿瘤检测效果较差。一种能够检测左侧和右侧病变的微创检测方法可以通过揭示右侧“盲点”中潜在的肿瘤存在，从而提高筛查结肠镜检查的有效性。
方法
我们之前报告了一个七基因、基于血液的生物标志物面板，该面板可有效分层患者发生 CRC 的风险。在本研究中，我们评估了七基因面板检测左侧和右侧 CRC 病变的有效性。对 314 例 CRC 患者（左侧：TNM I 期 65 例，TNM II 期 57 例，TNM III 期 60 例，TNM IV 期 17 例，未知 9 例；右侧：TNM I 期 28 例，TNM II 期 29 例，TNM III 期 38 例，TNM IV 期 12 例，未知 1 例，包括 2 例左右侧均有病变的样本）和 328 例对照样本进行了结果评估。在临床分期和治疗前采集血液样本。大多数 CRC 患者为局限性疾病（I 期和 II 期，58%）；区域（III 期）和全身（IV 期）疾病分别占研究人群的 32%和 9%。
结果
该面板检测到左侧（74%，154/208）和右侧（85%，92/108）病变，总体敏感性为 78%（215/316），特异性为 66%（215/328）。检测到可治疗的癌症（I 期至 III 期），左侧病变的敏感性为 76%（138/182），右侧敏感性为 84%（80/95）。
结论
该七基因生物标志物面板可检测所有癌症阶段的右侧 CRC 病变，其敏感性至少与左侧病变相当。本研究支持将该面板作为基础，开发一种患者友好型、基于血液的检测方法，该方法可在结肠镜检查前轻松纳入常规体检，提供便捷的伴随诊断和预筛查警报，最终提高 CRC 筛查的有效性。
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