Zou Jianhua, Xiao Zhanshuo, Wu Yu, Yang Jingyan, Cui Ning
China Academy of Chinese Medical Sciences Xiyuan Hospital, Beijing, China.
China Academy of Chinese Medical Sciences Guanganmen Hospital, Beijing, China.
Clin Chim Acta. 2022 Jan 1;524:123-131. doi: 10.1016/j.cca.2021.10.030. Epub 2021 Oct 28.
Colorectal cancer (CRC) is the third most common malignancy worldwide, with the second highest mortality rate among all malignancies. In this review, we describe the current utility of stool diagnostic biomarkers for CRC.
We reviewed stool-related tests and biomarker candidates for the diagnosis of CRC. The guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), and multitarget stool DNA test (MT-sDNA) have been used as clinical CRC screening tools. Although microRNAs, protein biomarkers, and microbiota have not yet been used in clinical CRC screening, there is growing evidence that they have the potential to function as CRC screening tools.
According to the literature, the sensitivity of MT-sDNA for detecting CRC was 87.0-100%, 32.7-82.0% for advanced adenomas, and the specificity was 86.1-95.2%. The sensitivity of individual biomarkers of fecal microRNAs for detecting CRC was 34.2-88.2%, 73.0% for advanced adenomas, and the specificity was 68-100%. The sensitivity of fecal protein markers for detecting CRC was 63.6-93.0%, 47.7-69.4% for advanced adenomas, and the specificity was 38.3-97.5%. The sensitivity of fecal microbiota for detecting CRC was 54.0-100.0%, 32.0-48.3% for advanced adenomas, and the specificity was 61.3-90.0%.
MT-sDNA is the most sensitive CRC screening test, and its sensitivity is the highest for advanced adenomas; however, its detection cost is high. MT-sDNA was more sensitive to CRC and advanced precancerous lesions than FIT, but compared to three years of MT-sDNA, annual FIT as the first non-invasive screening test for CRC seemed to be more effective.
结直肠癌（CRC）是全球第三大常见恶性肿瘤，在所有恶性肿瘤中死亡率排名第二。在本综述中，我们描述了粪便诊断生物标志物在CRC诊断中的当前应用。
我们回顾了用于CRC诊断的粪便相关检测和生物标志物候选物。基于愈创木脂的粪便潜血试验（gFOBT）、粪便免疫化学试验（FIT）和多靶点粪便DNA检测（MT-sDNA）已被用作临床CRC筛查工具。尽管微小RNA、蛋白质生物标志物和微生物群尚未用于临床CRC筛查，但越来越多的证据表明它们有潜力作为CRC筛查工具。
根据文献，MT-sDNA检测CRC的敏感性为87.0 - 100%，检测进展期腺瘤的敏感性为32.7 - 82.0%，特异性为86.1 - 95.2%。粪便微小RNA的单个生物标志物检测CRC的敏感性为34.2 - 88.2%，检测进展期腺瘤的敏感性为73.0%，特异性为68 - 100%。粪便蛋白质标志物检测CRC的敏感性为63.6 - 93.0%，检测进展期腺瘤的敏感性为47.7 - 69.4%，特异性为38.3 - 97.5%。粪便微生物群检测CRC的敏感性为54.0 - 100.0%，检测进展期腺瘤的敏感性为32.0 - 48.3%，特异性为61.3 - 90.0%。
MT-sDNA是最敏感的CRC筛查试验，对进展期腺瘤的敏感性最高；然而，其检测成本较高。MT-sDNA对CRC和癌前病变的敏感性高于FIT，但与三年的MT-sDNA相比，每年进行FIT作为CRC的首次非侵入性筛查试验似乎更有效。
