Cano Francisco Xavier, Duque José María, Seoane Lucia, Puga-Tejada Miguel, Espinoza de Los Monteros Alejandra, Bermeo Pablo, Junquera Eduardo, Pérez Daniel, Martin-Delgado Jimmy, Santelli Monica, Pérez Carla, Pérez Rivera Francisco Javier
Instituto de Investigación e Innovación en Salud Integral, Universidad Católica de Santiago de Guayaquil, Guayaquil 090615, Guayas, Ecuador.
Department of Gastroenterology, Hospital de Especialidades Alfredo G. Paulson, Guayaquil 090514, Guayas, Ecuador.
World J Gastroenterol. 2025 Sep 14;31(34):109718. doi: 10.3748/wjg.v31.i34.109718.
Elevated plasma homocysteine (Hcy) levels are associated with increased risk of colorectal cancer (CRC), particularly in patients with systemic inflammation or chronic conditions.
To evaluate serum Hcy levels as a predictive marker of lesion risk and CRC to prioritize patients undergoing diagnostic colonoscopy.
We conducted a prospective cohort study of 301 fecal occult blood test-positive patients at San Agustín University Hospital in Asturias, Spain. Plasma Hcy levels were measured prior to the colonoscopy and classified into three thresholds: ≤ 12, 12-15, and > 15 μmol/L. Colonoscopy and histopathology determined the presence of low-risk, high-risk polyps or adenocarcinoma. Predictive performance of serum Hcy to detect lesions was assessed using logistic regression and diagnostic accuracy measures, including models adjusted for age and sex.
Median Hcy levels rose progressively with lesion severity, reaching 15.3 μmol/L in adenocarcinoma ( < 0.001). Higher levels were also observed in men and individuals aged 65 or older. A threshold above 15 μmol/L showed good sensitivity (76.6%) and positive predictive value (87.2%) for detecting adenocarcinoma. When combined with age and sex, predictive accuracy improved (area under the receiver operating characteristic curve = 0.706). Based on these findings, we propose a three-tier triage system: Green (≤ 12 μmol/L in both sexes, colonoscopy within three months), Yellow (> 12-15 μmol/L in men, intervention within one month and red (≥ 15 in either sex or > 12 μmol/L in women, immediate colonoscopy).
Serum Hcy is a clinically useful biomarker for identifying high-risk colorectal lesions and cancer, particularly when interpreted in combination with age and sex. This composite model improves predictive accuracy and enables a structured three-tiered triage system that supports faster colonoscopy scheduling for at-risk groups. The traffic light approach offers a low cost, scalable strategy to reduce delays and optimize resource use in CRC screening, especially in public health systems with limited endoscopic capacity.
血浆同型半胱氨酸（Hcy）水平升高与结直肠癌（CRC）风险增加相关，尤其在全身炎症或慢性病患者中。
评估血清Hcy水平作为病变风险和CRC的预测标志物，以便对接受诊断性结肠镜检查的患者进行优先排序。
我们对西班牙阿斯图里亚斯圣阿古斯丁大学医院301名粪便潜血试验阳性患者进行了一项前瞻性队列研究。在结肠镜检查前测量血浆Hcy水平，并分为三个阈值：≤12、12 - 15和>15 μmol/L。结肠镜检查和组织病理学确定低风险、高风险息肉或腺癌的存在。使用逻辑回归和诊断准确性指标评估血清Hcy检测病变的预测性能，包括针对年龄和性别调整的模型。
Hcy水平中位数随病变严重程度逐渐升高，腺癌患者中达到15.3 μmol/L（<0.001）。男性和65岁及以上个体中也观察到较高水平。高于15 μmol/L的阈值对检测腺癌显示出良好的敏感性（76.6%）和阳性预测值（87.2%）。当与年龄和性别结合时，预测准确性提高（受试者工作特征曲线下面积 = 0.706）。基于这些发现，我们提出了一个三级分诊系统：绿色（男女均≤12 μmol/L，三个月内进行结肠镜检查）、黄色（男性>12 - 15 μmol/L，一个月内进行干预）和红色（任何性别≥15 μmol/L或女性>12 μmol/L，立即进行结肠镜检查）。
血清Hcy是识别高风险结直肠病变和癌症的临床有用生物标志物，尤其是与年龄和性别结合进行解读时。这种综合模型提高了预测准确性，并启用了结构化的三级分诊系统，支持为高危人群更快地安排结肠镜检查。红绿灯方法提供了一种低成本、可扩展的策略，以减少延迟并优化CRC筛查中的资源使用，特别是在内镜检查能力有限的公共卫生系统中。
