Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
Department of Pediatrics, National Taiwan University Children's Hospital and National Taiwan University, Taipei, Taiwan.
Cancer Med. 2019 Jul;8(7):3583-3591. doi: 10.1002/cam4.2216. Epub 2019 May 7.
Colorectal cancer (CRC) is one of the most common cancers worldwide. Screening for CRC using the fecal occult blood test (FOBT) is feasible and useful for decreasing disease-related mortality; however, its sensitivity and compliance are unsatisfactory.
This study examined the efficacy of using serum placenta growth factor (PlGF) for a novel CRC screening strategy. To investigate a potential novel screening tool for CRC, we compared the sensitivity, specificity, positive predictive value, and negative predictive value of the FOBT, serum PlGF, and their combination through an examination of two independent cohorts and validation using the second cohort. All the patients and control group received the colonoscopy and FOBT, the colonoscopy was used as the gold standard for the result.
Serum PlGF levels were significantly increased in CRC patients (16.8 ± 11.4 pg/mL) compared with controls (12.0 ± 11.2 pg/mL). The predictive model that used the serum PlGF level alone was as effective as the FOBT (AUC: 0.60 vs 0.68, P = 0.891), and it had significantly higher sensitivity than the FOBT (0.81 vs 0.39). In addition, we found serum PlGF level has a good value for predicting CRC patients in those FOBT negative populations. Finally, combining serum PlGF level and the FOBT improved the predictive power and demonstrated satisfactory sensitivity (0.71) and specificity (0.71). This result was confirmed and validated in the second independent cohort. Furthermore, no matter the stages (early/advanced) and the location (distal/proximal) of CRC, the efficacy of serum PlGF and the combined model remained quite stable.
Serum PlGF level is a potential alternative screening tool for CRC, especially for those who are reluctant to stool-based screening methods and who were tested as negative FOBT. In addition, combining serum PlGF level and the FOBT could increase the power of CRC screening.
结直肠癌（CRC）是全球最常见的癌症之一。使用粪便潜血试验（FOBT）筛查 CRC 是可行且有效的，可以降低与疾病相关的死亡率；然而，其敏感性和依从性并不令人满意。
本研究探讨了使用血清胎盘生长因子（PlGF）进行新型 CRC 筛查策略的效果。为了研究 CRC 的潜在新型筛查工具，我们通过两个独立队列的检查以及对第二个队列的验证，比较了 FOBT、血清 PlGF 及其组合的敏感性、特异性、阳性预测值和阴性预测值。所有患者和对照组均接受了结肠镜检查和 FOBT，将结肠镜检查作为结果的金标准。
与对照组（12.0±11.2 pg/mL）相比，CRC 患者的血清 PlGF 水平显著升高（16.8±11.4 pg/mL）。单独使用血清 PlGF 水平的预测模型与 FOBT 一样有效（AUC：0.60 与 0.68，P=0.891），并且其敏感性明显高于 FOBT（0.81 与 0.39）。此外，我们发现血清 PlGF 水平在 FOBT 阴性人群中对预测 CRC 患者具有良好的价值。最后，联合血清 PlGF 水平和 FOBT 提高了预测能力，并表现出令人满意的敏感性（0.71）和特异性（0.71）。这一结果在第二个独立队列中得到了证实和验证。此外，无论 CRC 的分期（早期/晚期）和部位（远端/近端）如何，血清 PlGF 及其组合模型的疗效均相当稳定。
血清 PlGF 水平是 CRC 的一种潜在替代筛查工具，尤其是对于那些不愿意接受基于粪便的筛查方法且 FOBT 检测为阴性的患者。此外，联合血清 PlGF 水平和 FOBT 可以提高 CRC 筛查的效能。
