Ann Intern Med:如何通过粪便更精准的筛查结直肠癌?

2021-07-21 MedSci原创 MedSci原创

与FIT相比,mtFIT在检测高级别赘生物方面表现出了更好的诊断准确性

结直肠癌 (CRC) 是全球癌症发病率和死亡的主要原因之一。从结直肠癌癌前病变、腺瘤或锯齿状息肉逐步进展为 CRC 可能需要数十年的时间,这为通过筛查及早发现和拦截留下了机会之窗。粪便免疫化学检测 (FIT) 用于CRC筛查,但仍有可改进的余地

这是一项诊断测试准确性研究,旨在开发具有比FIT更好的诊断性能的多目标FIT(mtFIT)。共招募了1284位患者(1038位来自筛查,246位来自转诊),根据最后随访的病变进行分类:CRC(n=47)、高级别腺瘤(n=135)、高级别锯齿状息肉(n=30)、非高级别腺瘤(n=250)和非高级别锯齿状息肉(n=53),以及对照个体(n=769)。

开发了基于抗体的检测方法并将其应用于剩余的FIT材料。采用分类和回归树 (CART) 分析生物标志物浓度,以确定检测高级别赘生物的最佳组合。

9 种蛋白质生物标志物在1284份FIT样本中的丰度差异

CART分析显示,结合血红蛋白、钙保护蛋白和serpin家族成员2——mtFIT——对高级别赘生物的交叉验证敏感性为42.9%,而FIT的交叉验证敏感性为37.3%(p=0.025),特异性相同,均为96.6%。特别值得注意的是,高级别赘生物的交叉验证敏感性从28.1%增加到了37.8%(p=0.006)。基于这些结果,早期健康技术评估表明,基于mtFIT的筛查可能比FIT具有成本效益。

综上所述,与FIT相比,mtFIT在检测高级别赘生物方面表现出了更好的诊断准确性,高级别腺瘤的检出率明显增加。此外,早期卫生技术评估表明,这些结果为进一步开发mtFIT作为未来基于人群的CRC筛查测试提供了良好的基础。

原始出处:

de Klaver Willemijn,Wisse Pieter H A,van Wifferen Francine et al. Clinical Validation of a Multitarget Fecal Immunochemical Test for Colorectal Cancer Screening : A Diagnostic Test Accuracy Study.[J] .Ann Intern Med, 2021, https://doi.org/10.7326/M20-8270

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    2021-07-23 Homburg
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