Background and Aims: We reported that fecal RNA test (FRT), detecting mRNA of COX2 and/or MMP-7 and/or Snail in feces, was superior to a single fecal immunochemical test (FIT) in term of sensitivity and specificity for colorectal cancer (CRC). (Gastroenterology 132(4): A-623, 2007). FIT is an excellent screening method of CRC, however, it is hard to make a qualitative diagnosis such as a rough stage of CRC. It is very interesting to examine whether FRT can predict a rough stage of CRC. Methods: Standard histological techniques were used to classify at 0 (TNM 0 is carcinoma in situ) to IV stage according to TNM classification, yielding stage 0 (n = 2), I (n = 12), II (n = 30), III (n = 14), and IV (n = 12). We purified RNA from routinely collected stool samples and screened mRNA using COX2, MMP-7 and Snail specific nested RT-PCR, which expression level was clarified in fifth grades (0: negative, 1-4: weakly to strongly positive). Results: Stool samples from 70 patients with CRC and 34 control patients without neoplastic or inflammatory disease were studied. By optimizing PCR conditions, the specificity of FRT was 100% [95% confidence interval (CI), 91.6%-100%]. The sensitivity of fecal COX-2 assay was 85.3% (95% CI; 75.3%-92.9%), 64.2% (95% CI, 51.9%-75.4%) for fecal MMP-7 assay and 51.4% (95% CI, 39.2%-63.6%) for fecal Snail assay, respectively. Consequently, FRT had 90% sensitivity (95% CI, 80.5%95.9%). The sensitivity of FRT was 78.6% (95% CI, 49.2%-95.3%) of stage 0 or I, 96.7% (95% CI, 82.8%-99.9%) of stage II, and 88.5% (95% CI, 69.8%-97.5%) of stage III or IV. Among patients with stage 0, I, or II, who are often cured by endoscopic or surgical resection, FRT had 90.9% sensitivity (95% CI, 78.3%-97.5%). FRT had 87.5% sensitivity (95% CI, 67.6%-91.3%) for detection of tumors proximal to the splenic flexure, and 91.3% sensitivity (95% CI, 79.2%-97.6%) for detection of tumors distal to the splenic flexure. Median expression level of each assay was 1 vs. 1 for COX-2, 0 vs. 3 for MMP-7, 0 vs. 1 for Snail (early cancer Vs. advanced cancer), respectively. Expression level of fecal COX-2 assay for advanced cancer was significantly higher than that of early cancer (P < 0.05, Mann-Whitney test). When expression level of each assay was more than 2, the positive predictive value for advanced cancer was 89.7% for COX-2, 85.7% for MMP-7, and 91.7% for Snail, respectively. Conclusions: Fecal RNA test had high sensitivity and high specificity for CRC. FRT may predict CRC whether it is advanced cancer or not. These results suggest that FRT would be a screening method of CRC with a potential of predicting rough stage.
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