Using serum placenta growth factor could improve the sensitivity of colorectal cancer screening in fecal occult blood negative population: A multicenter with independent cohort validation study.

Shu‐Chen Wei,Jau‐Min Wong,Been‐Ren Lin,Yu‐Ting Wang,Wen‐Sy Tsai,Po‐Nien Tsao,Jinn‐Shiun Chen,Deng‐Chyang Wu

doi:10.1002/cam4.2216

Abstract

BackgroundColorectal cancer (CRC) is one of the most common cancers worldwide. Screening for CRC using the fecal occult blood test (FOBT) is feasible and useful for decreasing disease‐related mortality; however, its sensitivity and compliance are unsatisfactory.MethodsThis study examined the efficacy of using serum placenta growth factor (PlGF) for a novel CRC screening strategy. To investigate a potential novel screening tool for CRC, we compared the sensitivity, specificity, positive predictive value, and negative predictive value of the FOBT, serum PlGF, and their combination through an examination of two independent cohorts and validation using the second cohort. All the patients and control group received the colonoscopy and FOBT, the colonoscopy was used as the gold standard for the result.ResultsSerum PlGF levels were significantly increased in CRC patients (16.8 ± 11.4 pg/mL) compared with controls (12.0 ± 11.2 pg/mL). The predictive model that used the serum PlGF level alone was as effective as the FOBT (AUC: 0.60 vs 0.68, P = 0.891), and it had significantly higher sensitivity than the FOBT (0.81 vs 0.39). In addition, we found serum PlGF level has a good value for predicting CRC patients in those FOBT negative populations. Finally, combining serum PlGF level and the FOBT improved the predictive power and demonstrated satisfactory sensitivity (0.71) and specificity (0.71). This result was confirmed and validated in the second independent cohort. Furthermore, no matter the stages (early/advanced) and the location (distal/proximal) of CRC, the efficacy of serum PlGF and the combined model remained quite stable.ConclusionSerum PlGF level is a potential alternative screening tool for CRC, especially for those who are reluctant to stool‐based screening methods and who were tested as negative FOBT. In addition, combining serum PlGF level and the FOBT could increase the power of CRC screening.

Highlights

Colorectal cancer (CRC) is the third most common cancer globally, with over 1.3 million cases that account for 10% of all cancers; it results in roughly 700 000 deaths per year.[1]
We demonstrated through the use of two independent cohorts that testing the serum placenta growth factor (PlGF) level was as effective as the fecal occult blood test (FOBT) for CRC screening
The predictive power and sensitivity to identify CRC patients were significantly increased through the use of the combination of serum PlGF level and the FOBT, and the combination significantly decreased the false negative rate

Summary

Introduction

Colorectal cancer (CRC) is the third most common cancer globally, with over 1.3 million cases that account for 10% of all cancers; it results in roughly 700 000 deaths per year.[1]. To investigate a potential novel screening tool for CRC, we compared the sensitivity, specificity, positive predictive value, and negative predictive value of the FOBT, serum PlGF, and their combination through an examination of two independent cohorts and validation using the second cohort. Results: Serum PlGF levels were significantly increased in CRC patients (16.8 ± 11.4 pg/mL) compared with controls (12.0 ± 11.2 pg/mL). Combining serum PlGF level and the FOBT improved the predictive power and demonstrated satisfactory sensitivity (0.71) and specificity (0.71). This result was confirmed and validated in the second independent cohort. Conclusion: Serum PlGF level is a potential alternative screening tool for CRC, especially for those who are reluctant to stool‐based screening methods and who were tested as negative FOBT. Combining serum PlGF level and the FOBT could increase the power of CRC screening

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