Progress of new technologies about early diagnosis of colorectal
-
摘要: 结直肠癌的发病率很高,早期诊断及早期治疗可以提高病人的预后,可以增加患者的生存率。因此,早期诊断对于结直肠癌显得尤为重要。随着大家对其越来越重视,各种检测方法陆续出现,各种分子标记物的敏感性及特异性不断提高。本篇综述从排泄物、血、影像学、内镜等方面概括了近几年对于早期结直肠癌诊断研究的新进展,对比了不同方法的敏感性、特异性以及各自的优缺点,有助于临床选择及评判。Abstract: The incidence of colorectal cancer is very high. Early diagnosis and early treatment can improve the prognosis of patients, and can increase the survival rate of patients. Therefore, early diagnosis of colorectal cancer is significant for colorectal cancer. As more people attach importance to it, various detection methods appear, and the sensitivity and specificity of various molecular markers are continuously increasing. This review summarized the recent advances in the diagnosis of early colorectal cancer, and compared sensitivity, specificity, and advantage and disadvantage between different methods.
-
Key words:
- colorectal cancer /
- early diagnosis /
- endocytoscopy computer-aided diagnosis /
-
表 1 各种检测方法敏感性、特异性、优缺点比较
检测方法 敏感性 特异性 优点 缺点 粪便中蛋白质的联合检测 晚期腺瘤 45% 95% 1. 所需标本量小,易于获取。2. 联合检测优于用血红蛋白单独检测。 1. 费用高,技术要求高,当检查结果为阳性时仍需行内镜检查以确诊。 CRC 80% 检测粪便中的微生物因子 C. symbiosum 晚期腺瘤 37%~58% 无 1. 操作简便、无创、安全性高。2. 作为一种初筛的手段,比镜检方便且易于实施。 1. 当检查结果为具有“高风险”微生物模式的患者仍需行内镜检查以确诊。 早期CRC 50%~60% clbA+细菌 56.4% 81.5% F. nucleatu 69.2% 76.9% 联合检测以上两种指标 84.6% 63.1% 血浆甲基化基因的检测 小息肉 33.3% 90.9% 1. 无创,患者易于接受。2. 易于操作。3. 特异性较高。 1. 敏感度较低。2. 单独应用时对进展期腺瘤的检出率仍较低。 CRC 90.0% 尿液代谢物组学联合检测 87.5% 91.3% 1. 非侵入性的早期肿瘤检测方法。2. 阐明了潜在的驱动CRC的潜在代谢机制。 1. 需要多种标记物联合检测,较为复杂。 电纺混合纤维垫 无 无 1. 成本低、无创。2. 灵敏度较高。 1. 对I期结直肠癌的诊断准确性不足。 血液中肿瘤标志物的联合检测 早期CRC 66.7% 80% 1. 与单独检测自身抗体标记物相比,多种TAA联合可以更好地区分肿瘤患者的血清和正常人的血清。 1. 种类繁多,各标志物的特异度、灵敏度均较低且存在较大区别。2. 选用单一的肿瘤标志物检测往往无法取得较好的效果。 晚期CRC 62% 血液中肿瘤标志物联合CEA检测 早期CRC 88.3% 83.7% 同上,但当这四种抗体再联合癌胚抗原一同检测时,其特异性,敏感性都增加。 晚期CRC 84% -
[1] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 29(6): 115-32 [2] Siegel RL, Miller KD, Fedewa SA, et al. Colorectal cancer statistics, 2017[J]. CA Cancer J Clin, 2018, 32(7): 177-93 [3] Bosch L, de Wit M, Pham TV, et al. Novel stool-based protein biomarkers for improved colorectal cancer screening: a case-control study[J]. Ann Intern Med, 2017, 31(16): 855-66 [4] Xie YH, Gao QY, Cai GX, et al. Fecal clostridium symbiosum for noninvasive detection of early and advanced colorectal cancer: test and validation studies[J]. Bio Med, 2017, 25(1): 32-40 [5] Eklof V, Lofgren-Burstrom A, Zingmark C, et al. Cancer-associated fecal microbial markers in colorectal cancer detection[J]. Int J Cancer, 2017, 141(20): 2528-36 [6] Oh TJ, Oh HI, Seo YY, et al. Feasibility of quantifying SDC2 methylation in stool DNA for early detection of colorectal cancer[J]. Clin Epigenetics, 2017, 25(9): 126-32 [7] Wang Z, Lin Y, Liang J, et al. NMR-based metabolomic techniques identify potential urinary biomarkers for early colorectal cancer detection[J]. Oncotarget, 2017, 32(8): 105819-31 [8] Lee AW, Lin FX, Wei PL, et al. Binary-blend fibber-based capture assay of circulating tumor cells for clinical diagnosis of colorectal cancer[J]. J Nanobiotechnology, 2018, 16(1): 4-9 doi: 10.1186/s12951-017-0330-1 [9] Lim DH, Lee JH, Kim JW. Feasibility of CYFRA 21-1 as a serum biomarker for the detection of colorectal adenoma and advanced colorectal adenoma in people over the age of 45[J]. J Clin Lab Anal, 2016, 32(3): 315-9 [10] Fan CW, Kuo YB, Lin GP, et al. Development of a multiplexed tumor-associated autoantibody-based blood test for the detection of colorectal cancer[J]. Clin Chim Acta, 2017, 475(2): 157-63 [11] Yu J, Zhai X, Li X, et al. Identification of MST1 as a potential early detection biomarker for colorectal cancer through a proteomic approach[J]. Sci Rep, 2017, 33(7): 14265-72 [12] Soares F, Becker K, Anzanello MJ. A hierarchical classifier based on human blood plasma fluorescence for non-invasive colorectal cancer screening[J]. Artif Intell Med, 2017, 82(1): 1-10 [13] Misawa M, Kudo SE, Mori Y, et al. Accuracy of computer-aided diagnosis based on narrow-band imaging endocytoscopy for diagnosing colorectal lesions: comparison with experts[J]. Int J Comput Assist Radiol Surg, 2017, 12(7): 757-66 [14] Ziemlewicz TJ, Kim DH, Hinshaw JL, et al. Computer-aided detection of colorectal polyps at CT colonography: prospective clinical performance and third-party reimbursement[J]. Am J Roentgenol, 2016, 208(12): 1244-8 [15] Atkin W, Wooldrage K, Parkin DM, et al. Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up: the UK Flexible Sigmoidoscopy Screening randomised controlled trial[J]. Lancet, 2017, 389(12): 1299-311 [16] Nishihara R, Wu K, Lochhead P, et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy[J]. N Engl J Med, 2017, 369(10): 1095-105 [17] Sako T, Kudo SE, Miyachi H, et al. A novel ability of endocytoscopy to diagnose histological grade of differentiation in T1 colorectal carcinomas[J]. Endoscopy, 2018, 50(1): 69-74 [18] Willyard C. To foster screening, new colon cancer tests emphasize convenience[J]. Nat Med, 2014, 20(3): 322-3 [19] Adler A, Geiger S, Keil A, et al. Improving compliance to colorectal cancer screening using blood and stool based tests in patients refusing screening colonoscopy in Germany[J]. BMC Gastroenterol, 2014, 38(14): 183-9
点击查看大图
表(1)
计量
- 文章访问数: 2444
- HTML全文浏览量: 974
- PDF下载量: 14
- 被引次数: 0