Abstract
Background
Invasive colonoscopy is the gold standard for patients at risk for colorectal cancer. However, the need for non-invasive and specific markers is required.
Objective
To evaluate the sensitivity of the glycolytic pyruvate kinase isoenzyme type M2 dimer (M2PK) as a diagnostic biomarker for colorectal cancer (CRC) and adenomatous colorectal polyps (CRP) screening.
Design
Case-control.
Patients
Twenty patients with CRC, 20 patients with CRP (lack criteria for colonic cancer by biopsy), and 20 normal subjects.
Outcome
Complete blood count (CBC), erythrocyte sedimentation rate (ESR), tumor markers: carcino embryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9), fecal occult blood test (FOBT), and fecal M2PK. Pelvic and abdominal ultrasound (US), colonoscopy, and a histopathological examination.
Results
Only weight loss and cachexia were significantly associated with CRC than CRP or control groups. M2PK was the most sensitive and specific test in differentiating CRC from CRP and the control subjects (sensitivity = 75%, specificity = 100%).
Limitations
(1) The selection of cases for three well-matched groups, as to perform colonoscopy in well-prepared cases and conditions. (2) Replicates in more than 20 cases for confirmation at the expense of enrolling new patients. (3) The cost associated with tumor markers analysis.
Conclusion
Fecal M2PK can be used as a precolonoscopy screening test for CRC patients, and is superior to other tumor markers, and in indicating the progress of colorectal adenomas > 1 cm. Thus being cost-effective and easy-to-perform test, it is a feasible tool to preselect patients who require colonoscopy.
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Abbreviations
- ANOVA :
-
analysis of variance
- BPR :
-
bleeding per rectum
- CA 19-9 :
-
carbohydrate antigen 19-9
- CEA :
-
carcino embryonic antigen
- CRP :
-
colorectal (adenomatous) polyps
- CRC :
-
colorectal cancer
- CT :
-
computerized tomography
- Ctrl :
-
control
- DA :
-
diagnostic accuracy
- DM :
-
diabetes mellitus
- ELISA :
-
enzyme-linked immunosorbent assay
- ESR :
-
erythrocyte sedimentation rate
- FOBT :
-
fecal occult blood test
- HTN :
-
hypertension
- INR :
-
international normalized ratio
- LR :
-
likelihood ratio
- NCI :
-
National Cancer Institute
- NPV :
-
negative predictive value
- PTT :
-
partial thromboplastin time
- PT :
-
prothrombin time
- PPV :
-
positive predictive value
- M2PK :
-
pyruvate kinase isoenzyme type M2
- ROC :
-
receiver operating characteristic
- SPSS :
-
Statistical Package for Social Sciences
- AUC :
-
area under the curve
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Acknowledgements
All the authors contributed equally to conception, writing the manuscript, and the analysis of data included in this article. D.J. supported the Endnote X8 software required for this article.
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The study ethics protocol was approved by the Tropical Medicine Department, Ain-Shams University and the Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute, Cairo, Egypt.
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Written consent to participate was given by all patients who were enrolled in the study.
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Dabbous, H.K., Mohamed, Y.AR., El-Folly, R.F. et al. Evaluation of Fecal M2PK as a Diagnostic Marker in Colorectal Cancer. J Gastrointest Canc 50, 442–450 (2019). https://doi.org/10.1007/s12029-018-0088-1
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DOI: https://doi.org/10.1007/s12029-018-0088-1