Gies Anton, Cuk Katarina, Schrotz-King Petra, Brenner Hermann
Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.
Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany.
United European Gastroenterol J. 2018 Oct;6(8):1223-1231. doi: 10.1177/2050640618784053. Epub 2018 Jun 12.
Fecal transferrin has been suggested as a complementary or even superior marker for early detection of colorectal cancer (CRC) besides fecal hemoglobin. We aimed to evaluate both markers individually and in combination in a large cohort of participants of screening colonoscopy.
Precolonoscopy stool samples were obtained from participants of screening colonoscopy and frozen at -80℃ until blinded analysis, using a dual-quantitative fecal immunochemical test (FIT) for hemoglobin and transferrin. Sensitivity, specificity and area under the curve (AUC) were calculated for CRC and advanced adenoma (AA).
A total of 1667 participants fulfilled our inclusion criteria. All individuals with advanced neoplasm (AN) (16 CRC, 200 AA) and 300 randomly selected participants without AN were included. Mean age was 63 years and 56% were male. The AUC for CRC and AA was 92% and 68%, respectively, for hemoglobin vs. 79% and 58%, respectively for transferrin. Combination of both markers yielded an AUC for CRC and AA of 92% and 68%, respectively.
FIT for hemoglobin shows better diagnostic performance than FIT for transferrin for the detection of ANs (both proximal and distal neoplasms), and a combination of both markers does not improve the diagnostic performance.
除粪便血红蛋白外，粪便转铁蛋白已被认为是早期检测结直肠癌（CRC）的一种补充性甚至更优的标志物。我们旨在对大量结肠镜筛查参与者队列中的这两种标志物进行单独及联合评估。
从结肠镜筛查参与者中获取结肠镜检查前的粪便样本，并在-80℃下冷冻，直至采用针对血红蛋白和转铁蛋白的双定量粪便免疫化学检测（FIT）进行盲法分析。计算CRC和高级别腺瘤（AA）的敏感性、特异性和曲线下面积（AUC）。
共有1667名参与者符合我们的纳入标准。纳入了所有患有高级别肿瘤（AN）的个体（16例CRC，200例AA）以及300名随机选择的无AN的参与者。平均年龄为63岁，56%为男性。对于CRC和AA，血红蛋白的AUC分别为92%和68%，而转铁蛋白的AUC分别为79%和58%。两种标志物联合使用时，CRC和AA的AUC分别为92%和68%。
用于检测血红蛋白的FIT在检测AN（近端和远端肿瘤）方面比用于检测转铁蛋白的FIT具有更好的诊断性能，且两种标志物联合使用并不能提高诊断性能。
