Department of Clinical Laboratory, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.
Sci Rep. 2022 Feb 16;12(1):2623. doi: 10.1038/s41598-022-06689-4.
Early diagnosis of colorectal advanced neoplasms (ANs), including colorectal cancer (CRC) and advanced adenoma (AA), has a positive effect on the survival rate. As a first attempt, the aim of this meta-analysis was to compare the diagnostic accuracy of faecal protein biomarkers for the detection of colorectal neoplasms with consideration of a wide range of covariates. A systematic literature search was performed up to Jun 10, 2021 on Web of Sciences, Scopus and PubMed. The diagnostic accuracies were calculated using the bivariate/hierarchical random effect model. Biomarkers were determined to be clinically applicable (CA) if they had areas under the curve > 0.70 and positive and negative likelihood ratios > 2 and < 0.5, respectively. A total of 47,059 test results were extracted from 16 immunochemical faecal occult blood test (iFOBT), 26 pyruvate kinase-M2 (PK-M2) and 23 faecal calprotectin (FC) studies. Only iFOBT, PK-M2 and FC for CRC plus iFOBT and PK-M2 for AN were CA. iFOBT had significantly superior accuracy (P = 0.02 versus PK-M2 and P < 0.01 versus FC for CRC; P < 0.01 versus PK-M2 for AN). Regarding covariates, the lateral flow method of PK-M2 measurement increased its accuracy for CRC detection compared to the enzyme-linked immunosorbent assay (P < 0.01). iFOBT is recommended as the most accurate faecal biomarker for CRC and AN diagnosis.
早期诊断结直肠进展性肿瘤（包括结直肠癌和高级腺瘤）对提高生存率有积极影响。本荟萃分析首次尝试考虑广泛的协变量，比较粪便蛋白生物标志物检测结直肠肿瘤的诊断准确性。截至 2021 年 6 月 10 日，我们在 Web of Sciences、Scopus 和 PubMed 上进行了系统的文献检索。使用双变量/分层随机效应模型计算诊断准确性。如果生物标志物的曲线下面积（AUC）>0.70，阳性和阴性似然比（LR）分别>2 和<0.5，则可判断其具有临床适用性（CA）。共从 16 项免疫化学粪便潜血试验（iFOBT）、26 项丙酮酸激酶 M2（PK-M2）和 23 项粪便钙卫蛋白（FC）研究中提取了 47059 项检测结果。仅 iFOBT、PK-M2 和 FC 对 CRC 具有 CA，iFOBT 和 PK-M2 对 AN 具有 CA。与 PK-M2 和 FC 相比，iFOBT 对 CRC 的检测准确性显著更高（P=0.02 和 P<0.01）；与 PK-M2 相比，iFOBT 对 AN 的检测准确性更高（P<0.01）。关于协变量，与酶联免疫吸附测定（ELISA）相比，PK-M2 检测的侧向流动法提高了 CRC 检测的准确性（P<0.01）。建议 iFOBT 作为最准确的结直肠肿瘤和 AN 诊断粪便生物标志物。
