Wilhelmsen Michael, Christensen Ib J, Rasmussen Louise, Jørgensen Lars N, Madsen Mogens R, Vilandt Jesper, Hillig Thore, Klaerke Michael, Nielsen Knud T, Laurberg Søren, Brünner Nils, Gawel Susan, Yang Xiaoqing, Davis Gerard, Heijboer Annemieke, Martens Frans, Nielsen Hans J
Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
Department of Surgical Gastroenterology, Bispebjerg Hospital, University of Copenhagen, København, Denmark.
Int J Cancer. 2017 Mar 15;140(6):1436-1446. doi: 10.1002/ijc.30558.
Serological biomarkers may be an option for early detection of colorectal cancer (CRC). The present study assessed eight cancer-associated protein biomarkers in plasma from subjects undergoing first time ever colonoscopy due to symptoms attributable to colorectal neoplasia. Plasma AFP, CA19-9, CEA, hs-CRP, CyFra21-1, Ferritin, Galectin-3 and TIMP-1 were determined in EDTA-plasma using the Abbott ARCHITECT® automated immunoassay platform. Primary endpoints were detection of (i) CRC and high-risk adenoma and (ii) CRC. Logistic regression was performed. Final reduced models were constructed selecting the four biomarkers with the highest likelihood scores. Subjects (N = 4,698) were consecutively included during 2010-2012. Colonoscopy detected 512 CRC patients, 319 colonic cancer and 193 rectal cancer. Extra colonic malignancies were detected in 177 patients, 689 had adenomas of which 399 were high-risk, 1,342 had nonneoplastic bowell disease and 1,978 subjects had 'clean' colorectum. Univariable analysis demonstrated that all biomarkers were statistically significant. Multivariate logistic regression demonstrated that the blood-based biomarkers in combination significantly predicted the endpoints. The reduced model resulted in the selection of CEA, hs-CRP, CyFra21-1 and Ferritin for the two endpoints; AUCs were 0.76 and 0.84, respectively. The postive predictive value at 90% sensitivity was 25% for endpoint 1 and the negative predictive value was 93%. For endpoint 2, the postive predictive value was 18% and the negative predictive value was 97%. Combinations of serological protein biomarkers provided a significant identification of subjects with high risk of the presence of colorectal neoplasia. The present set of biomarkers could become important adjunct in early detection of CRC.
血清生物标志物可能是早期检测结直肠癌(CRC)的一种选择。本研究评估了因结直肠肿瘤相关症状首次接受结肠镜检查的受试者血浆中的八种癌症相关蛋白生物标志物。使用雅培ARCHITECT®自动免疫分析平台测定EDTA血浆中的血浆甲胎蛋白(AFP)、癌抗原19-9(CA19-9)、癌胚抗原(CEA)、超敏C反应蛋白(hs-CRP)、细胞角蛋白19片段(CyFra21-1)、铁蛋白、半乳糖凝集素-3(Galectin-3)和基质金属蛋白酶组织抑制因子-1(TIMP-1)。主要终点为:(i)检测CRC和高危腺瘤;(ii)检测CRC。进行了逻辑回归分析。构建最终简化模型,选择似然分数最高的四种生物标志物。在2010年至2012年期间连续纳入受试者(N = 4698)。结肠镜检查发现512例CRC患者,其中319例为结肠癌,193例为直肠癌。在177例患者中检测到结肠外恶性肿瘤,689例有腺瘤,其中399例为高危腺瘤,1342例有非肿瘤性肠道疾病,1978例受试者的结肠直肠“正常”。单变量分析表明所有生物标志物均具有统计学意义。多变量逻辑回归表明,基于血液的生物标志物组合可显著预测终点。简化模型选择CEA、hs-CRP、CyFra21-1和铁蛋白用于两个终点;曲线下面积(AUC)分别为0.76和0.84。终点1在90%灵敏度下的阳性预测值为25%,阴性预测值为93%。对于终点2,阳性预测值为18%,阴性预测值为97%。血清学蛋白生物标志物组合可显著识别存在结直肠肿瘤高风险的受试者。本套生物标志物可能成为CRC早期检测的重要辅助手段。