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Abstract
Despite the steadily increasing worldwide incidence of colorectal cancer (CRC), an effective noninvasive approach for early detection of CRC is still under investigation. The guaiac-based fecal occult blood test (FOBT) and fecal immunochemical test (FIT) have gained popularity as noninvasive CRC screening tests owing to their convenience and relatively low costs. However, the FOBT and FIT have limited sensitivity and specificity. To develop a noninvasive tool for the detection of CRC, we investigated the sensitivity, specificity, and accuracy of a stool DNA test targeting methylated syndecan-2 (SDC2), which is frequently methylated in patients with CRC. The present study enrolled 62 patients diagnosed as having stage 0-IV CRC and 76 healthy participants between July 2018 and June 2019 from two institutions. Approximately 4.5 g of stool sample was collected from each participant for detection of human methylated SDC2 gene. In total, 48 of 62 (77.4%) patients with CRC showed positive results, whereas 67 out of 76 (88.2%) healthy participants showed negative results. The area under the curve of the receiver operating characteristic curve constructed was 0.872 for discrimination between patients with CRC and healthy individuals. The present study highlights the potential of the fecal methylated SDC2 test as a noninvasive detection method for CRC screening with a relatively favorable sensitivity of 77.4%, a specificity of 88.2% and a positive predictive value of 84.2% compared with other available fecal tests. Further multicenter clinical trials comprising subjects of varied ethnicities are required to validate this test for the mass screening of patients with CRC.
Highlights
Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide and the fourth most common cause of cancer-related deaths [1,2]
Several studies have revealed that the mortality rate associated with CRC has steadily decreased over the past two decades owing to early detection through screening to identify and remove adenomatous polyps at the early disease stages, which increases the survival of patients with colorectal tumors [3,4,5,6]
To further develop a tool for the noninvasive detection of CRC, in two institutions, we investigated the sensitivity of the stool DNA test targeting methylated SDC2 that is frequently methylated in CRC [15]
Summary
Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide and the fourth most common cause of cancer-related deaths [1,2]. Several studies have revealed that the mortality rate associated with CRC has steadily decreased over the past two decades owing to early detection through screening to identify and remove adenomatous polyps at the early disease stages, which increases the survival of patients with colorectal tumors [3,4,5,6]. The guaiac-based fecal occult blood test (FOBT) and fecal immunochemical test (FIT) have gained popularity as noninvasive screening tools for CRC owing to their convenience and relatively low costs [7]. They help to detect human blood hemoglobin (Hb) in License 4.0 (CC BY). The FOBT and FIT have limited sensitivity and specificity, as patients with positive FOBT or FIT results would require colonoscopy to verify the etiology of potential bleeding within the gastrointestinal (GI) tract
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