Iannone Andrea, Losurdo Giuseppe, Pricci Maria, Girardi Bruna, Massaro Antonio, Principi Mariabeatrice, Barone Michele, Ierardi Enzo, Di Leo Alfredo
Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
J Gastrointest Cancer. 2016 Jun;47(2):143-51. doi: 10.1007/s12029-016-9810-z.
We report an update of current methods for colorectal cancer (CRC) screening based on fecal sample analysis.
A systematic review of the literature was performed in MEDLINE, EMBASE, and Science Direct electronic databases.
Blood in the stools is the first and most used strategy. Fecal occult blood test (FOBT) and fecal immunochemical test (FIT) are the main methods. Both are economic, easy to perform with high specificity, and low sensitivity. Based on CRC multi-step process with genetic and epigenetic alterations in large bowel cell DNA, single mutations or panels of alterations have been detected. These tests have the advantage of a marked improvement of the sensitivity when compared to fecal blood. However, high costs, poor availability, and correct choice of marker panel represent the major limits. A specific sDNA panel including aberrantly methylated BMP3 and NDRG4 promoter regions, mutant k-ras and β-actin (a reference gene for human DNA quantity), and an immunochemical assay for human hemoglobin has been recently approved by Food and Drug Administration. Novel promising biomarkers for CRC screening are represented by microRNAs (miRNAs), a group of 18-25 nucleotide non-coding RNA molecules that regulate gene expression. Reports on these fecal biomarkers are case-control studies, and each of them evaluates single miRNAs or multi-target panels. On the other hand, some fecal proteins have been studied as possible CRC screening markers, even though they demonstrated poor results. Finally, alterations of estrogen receptor-beta (i.e., dramatic reduction in the early stage of CRC) have been demonstrated in tissue samples.
Specific investigations are warranted in order to add further noninvasive markers to the panel of CRC screening tools.
我们报告了基于粪便样本分析的结直肠癌（CRC）筛查当前方法的最新情况。
在MEDLINE、EMBASE和科学Direct电子数据库中对文献进行了系统综述。
粪便潜血是首要且使用最广泛的策略。粪便潜血试验（FOBT）和粪便免疫化学试验（FIT）是主要方法。两者都经济、易于操作，具有高特异性和低灵敏度。基于CRC的多步骤过程，其中大肠细胞DNA存在遗传和表观遗传改变，已检测到单个突变或改变组合。与粪便潜血相比，这些检测的优势在于灵敏度有显著提高。然而，高成本、可用性差以及标记物组合的正确选择是主要限制因素。一种特定的sDNA组合，包括异常甲基化的BMP3和NDRG4启动子区域、突变的k-ras和β-肌动蛋白（人类DNA量的参考基因），以及一种针对人血红蛋白的免疫化学测定法，最近已获得美国食品药品监督管理局的批准。用于CRC筛查的新的有前景的生物标志物是微小RNA（miRNAs），这是一组18 - 25个核苷酸的非编码RNA分子，可调节基因表达。关于这些粪便生物标志物的报告都是病例对照研究，并且每个研究都评估单个miRNA或多靶点组合。另一方面，一些粪便蛋白也被作为可能的CRC筛查标志物进行了研究，尽管结果不佳。最后，在组织样本中已证实雌激素受体-β发生改变（即CRC早期显著降低）。
有必要进行具体研究，以便在CRC筛查工具组合中增加更多非侵入性标志物。
