a Department of Surgical Gastroenterology, Center for Surgical Research , Hvidovre Hospital , Hvidovre , Denmark.
b Digestive Disease Center , Bispebjerg Hospital , Copenhagen , Denmark.
Acta Oncol. 2019;58(sup1):S42-S48. doi: 10.1080/0284186X.2018.1540885. Epub 2018 Dec 7.
Blood-based, cancer-associated biomarkers may detect subjects at risk of having neoplastic diseases. The aim of the present study was to evaluate whether elevated serological protein biomarker levels may identify adenoma patients, who are at increased risk of being diagnosed with subsequent primary malignancy.
Levels of CEA, CA19-9, TIMP-1 and YKL-40 were determined in blood samples collected prior to diagnostic bowel endoscopy due to symptoms of colorectal neoplasia. Follow-up time was ten years, and identified adenoma patients, who were diagnosed with subsequent primary intra- or extra-colonic malignant diseases. The biomarker levels were also determined in 400 subjects, who underwent diagnostic colonoscopy, had clean colorectum and were without apparent co-morbidity; these levels were used as reference levels. In the present study, biomarkers were interpreted as elevated when levels were above the reference intervals adjusting for age and gender. The 1-year and 5-years cumulative incidences were calculated.
Primary malignancies were identified in 175 (19%) of the 923 subjects diagnosed with adenomas at the primary bowel endoscopy. In detail, 20 of the 175 subjects were diagnosed with colorectal cancer (CRC) and 155 subjects with extra-colonic cancers. Thirty patients were diagnosed with malignancy within the first year. Three groups were established: 0: no elevated biomarkers; 1: 1 of the 4 biomarkers elevated; and 2: ≥2 biomarkers elevated. The cumulative 5-years incidence of malignancy was: 0: 6.9%; 1: 11.8%; and 2: 17.5% (p = .0009).
Elevated blood-based, cancer-associated protein biomarker levels in subjects diagnosed with adenomas at large bowel endoscopy identifies subjects at increased risk of being diagnosed with subsequent primary malignancy.
基于血液的癌症相关生物标志物可用于检测有发生肿瘤性疾病风险的患者。本研究旨在评估血清蛋白生物标志物水平升高是否可以识别腺瘤患者，这些患者有更高的风险被诊断为随后发生的原发性恶性肿瘤。
在因结直肠肿瘤症状而进行诊断性肠内镜检查之前，采集血液样本，检测 CEA、CA19-9、TIMP-1 和 YKL-40 的水平。随访时间为 10 年，发现并诊断出腺瘤患者随后发生了原发性结直肠内或结直肠外恶性疾病。还在 400 例接受诊断性结肠镜检查、结直肠清洁且无明显合并症的患者中检测了这些生物标志物水平，这些水平被用作参考水平。在本研究中，当生物标志物水平超过按年龄和性别调整的参考区间时，将其解释为升高。计算了 1 年和 5 年的累积发生率。
在原发性肠内镜检查诊断为腺瘤的 923 例患者中，有 175 例（19%）患者发现原发性恶性肿瘤。具体而言，20 例患者被诊断为结直肠癌（CRC），155 例患者被诊断为结直肠外癌症。30 例患者在第 1 年内被诊断为恶性肿瘤。建立了 3 个组：0：无升高的生物标志物；1：4 种生物标志物中的 1 种升高；2：≥2 种生物标志物升高。恶性肿瘤的 5 年累积发生率分别为：0：6.9%；1：11.8%；2：17.5%（p=0.0009）。
在接受大肠内镜检查诊断为腺瘤的患者中，血液中与癌症相关的蛋白生物标志物水平升高可识别出具有更高风险被诊断为随后发生原发性恶性肿瘤的患者。
