Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Clin Transl Gastroenterol. 2019 Oct;10(10):e00088. doi: 10.14309/ctg.0000000000000088.
There is a significant unmet need for a blood test with adequate sensitivity to detect colorectal cancer (CRC) and adenomas. We describe a novel circulating tumor cell (CTC) platform to capture colorectal epithelial cells associated with CRC and adenomas.
Blood was collected from 667 Taiwanese adults from 2012 to 2018 before a colonoscopy. The study population included healthy control subjects, patients with adenomas, and those with stage I-IV CRC. CTCs were isolated from the blood using the CellMax platform. The isolated cells were enumerated, and an algorithm was used to determine the likelihood of detecting adenoma or CRC. Nominal and ordinal logistic regression demonstrated that CTC counts could identify adenomas and CRC, including CRC stage.
The CellMax test demonstrated a significant association between CTC counts and worsening disease status (Cuzick's P value < 0.0001) with respect to the adenoma-carcinoma sequence. The test showed high specificity (86%) and sensitivity across all CRC stages (95%) and adenomatous lesions (79%). The area under the curve was 0.940 and 0.868 for the detection of CRC and adenomas, respectively.
The blood-based CTC platform demonstrated high sensitivity in detecting adenomas and CRC, as well as reasonable specificity in an enriched symptomatic patient population.
If these results are reproduced in an average risk population, this test has the potential to prevent CRC by improving patient compliance and detecting precancerous adenomas, eventually reducing CRC mortality.
目前临床上需要一种具有足够灵敏度的血液检测方法来诊断结直肠癌（CRC）和腺瘤，但此类检测方法仍存在很大的未满足需求。本研究介绍了一种新型的循环肿瘤细胞（CTC）平台，用于捕获与 CRC 和腺瘤相关的结直肠上皮细胞。
本研究纳入了 2012 年至 2018 年间在结肠镜检查前采集的 667 名台湾成年人的血液样本。该研究人群包括健康对照者、腺瘤患者和 I-IV 期 CRC 患者。使用 CellMax 平台从血液中分离 CTC。对分离出的细胞进行计数，并使用算法确定检测到腺瘤或 CRC 的可能性。名义和 ordinal 逻辑回归显示 CTC 计数可识别腺瘤和 CRC，包括 CRC 分期。
CellMax 检测结果显示，CTC 计数与疾病恶化程度呈显著相关（Cuzick 检验 P 值＜0.0001），符合腺瘤-癌序列。该检测对所有 CRC 分期（95%）和腺瘤性病变（79%）均具有较高的特异性和敏感性。该检测对 CRC 和腺瘤的曲线下面积分别为 0.940 和 0.868。
基于血液的 CTC 平台在检测腺瘤和 CRC 方面具有较高的灵敏度，在症状丰富的患者人群中具有合理的特异性。
这是一篇关于一种新型循环肿瘤细胞（CTC）平台的研究论文。该平台旨在通过捕获与结直肠相关的上皮细胞来检测结直肠癌（CRC）和腺瘤。研究结果表明，该平台在检测 CRC 和腺瘤方面具有较高的灵敏度和特异性，具有潜在的临床应用价值。
