Skip to main content

Advertisement

Log in

Evaluation of Fecal M2PK as a Diagnostic Marker in Colorectal Cancer

  • Original Research
  • Published:
Journal of Gastrointestinal Cancer Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

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

References

  1. National Cancer Institute, Egypt. Cancer epidemiology in Egypt, the real magnitude of the problem. 2002.

  2. El-Attar I. Colo-rectal cancer: magnitude of the problem. Annual Cancer Conference of the Egyptian Cancer Society, Danish Cancer Society & Aarhus University Hospital (9–11 February, 2005).

  3. Waye JD, Kahn O, Auerbach ME. Complications of colonoscopy and flexible sigmoidoscopy. Gastrointest Endosc Clin N Am. 1996;6:343–77.

    Article  CAS  PubMed  Google Scholar 

  4. Kim YC, Kim JH, Cheung DY, Kim TH, Jun EJ, Oh JW, et al. The usefulness of a novel screening kit for colorectal cancer using the immunochromatographic fecal tumor M2 pyruvate kinase test. Gut Liver. 2015;9:641–8. https://doi.org/10.5009/gnl13457.

    Article  CAS  PubMed  Google Scholar 

  5. Kahi CJ, Rex DK. Screening and surveillance of colorectal cancer. Gastrointest Endosc Clin N Am. 15:3.

  6. Rex DK. Maximizing detection of adenomas and cancers during colonoscopy. Am J Gastroenterol. 2006;101:2866–77. https://doi.org/10.1111/j.1572-0241.2006.00905.x.

    Article  PubMed  Google Scholar 

  7. Macrae FA, St John DJ. Relationship between patterns of bleeding and Hemoccult sensitivity in patients with colorectal cancers or adenomas. Gastroenterology. 1982;82:891–8.

    CAS  PubMed  Google Scholar 

  8. Koss K, Maxton D, Jankowski JA. Faecal dimeric M2 pyruvate kinase in colorectal cancer and polyps correlates with tumour staging and surgical intervention. Color Dis. 2008;10:244–8. https://doi.org/10.1111/j.1463-1318.2007.01334.x.

    Article  CAS  Google Scholar 

  9. Smith RA, Cokkinides V, Eyre HJ. Cancer screening in the United States, 2007: a review of current guidelines, practices, and prospects. CA Cancer J Clin. 2007;57:90–104.

    Article  CAS  PubMed  Google Scholar 

  10. Quintero E, Castells A, Bujanda L, et al. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med. 2012;366:697–706.

    Article  CAS  PubMed  Google Scholar 

  11. Goonetilleke KS, Mason JM, Siriwardana P, King NK, France MW, Siriwardena AK. Diagnostic and prognostic value of plasma tumor M2 pyruvate kinase in periampullary cancer: evidence for a novel biological marker of adverse prognosis. Pancreas. 2007;34:318–24. https://doi.org/10.1097/MPA.0b013e31802ee9c7.

    Article  CAS  PubMed  Google Scholar 

  12. Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Fecal DNA versus fecal occult blood for colorectal cancer screening in an average risk population. N Engl J Med. 2004;351:2704–14.

    Article  CAS  PubMed  Google Scholar 

  13. Meng W, Zhu HH, Xu ZF, Cai SR, Dong Q, Pan QR, et al. Serum M2-pyruvate kinase: a promising non-invasive biomarker for colorectal cancer mass screening. World J Gastrointest Oncol. 2012;4:145–51. https://doi.org/10.4251/wjgo.v4.i6.145.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Hameed MA, & Waqas S. Physiological basis and clinical utility of erythrocyte sedimentation rate. Continuing Med Educ. 2006;22:214–18.

  15. Amatuzio DS, Grande F, Wada S. The cyanmethemoglobin method for hemoglobin determination. Minn Med. 1962;45:378–81.

    CAS  PubMed  Google Scholar 

  16. Lewis, S., Barbara, B. & Imelda, B. Dacie and Lewis Practical Haematology, 10th Edition. Churchill Livingstone. 2006.

  17. Fletcher RH. The diagnosis of colorectal cancer in patients with symptoms: finding a needle in a haystack. BMC Med. 2009;7:18. https://doi.org/10.1186/1741-7015-7-18.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Moslein G, et al. Analysis of the statistical value of various commercially available stool tests—a comparison of one stool sample in correlation to colonoscopy. Dtsch Med Wochenschr. 2010;135:557–62. https://doi.org/10.1055/s-0030-1247866.

    Article  CAS  PubMed  Google Scholar 

  19. Kim HJ, Kang HJ, Lee H, Lee ST, Yu MH, Kim H, et al. Identification of S100A8 and S100A9 as serological markers for colorectal cancer. J Proteome Res. 2009;8:1368–79. https://doi.org/10.1021/pr8007573.

    Article  CAS  PubMed  Google Scholar 

  20. Wang YR, Yan JX, Wang LN. The diagnostic value of serum carcino-embryonic antigen, alpha fetoprotein and carbohydrate antigen 19-9 for colorectal cancer. J Cancer Res Ther. 2014;10(Suppl):307–9. https://doi.org/10.4103/0973-1482.151538.

    Article  CAS  PubMed  Google Scholar 

  21. Tonus C, Sellinger M, Koss K, Neupert G. Faecal pyruvate kinase isoenzyme type M2 for colorectal cancer screening: a meta-analysis. World J Gastroenterol. 2012;18:4004–11. https://doi.org/10.3748/wjg.v18.i30.4004.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Sithambaram S, Hilmi I, Goh KL. The diagnostic accuracy of the M2 pyruvate kinase quick stool test—a rapid office based assay test for the detection of colorectal cancer. PLoS One. 2015;10:e0131616. https://doi.org/10.1371/journal.pone.0131616.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Bond AD, Burkitt MD, Sawbridge D, Corfe BM, Probert CS. Correlation between faecal tumour M2 pyruvate kinase and colonoscopy for the detection of adenomatous neoplasia in a secondary care cohort. J Gastrointestin Liver Dis. 2016;25:71–7. https://doi.org/10.15403/jgld.2014.1121.251.m2p.

    Article  PubMed  Google Scholar 

  24. O’Brien MJ, Winawer SJ, Zauber AG, et al. The National Polyp Study: patient and polyp characteristics associated with high grade dysplasia in colorectal adenomas. Gastroenterology. 1990;98:371–9.

    Article  PubMed  Google Scholar 

  25. Mroczko B, Groblewska M, Okulczyk B, Kedra B, Szmitkowski M. The diagnostic value of matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of matrix metalloproteinases 1 (TIMP-1) determination in the sera of colorectal adenoma and cancer patients. Int J Color Dis. 2010;25:1177–84. https://doi.org/10.1007/s00384-010-0991-9.

    Article  Google Scholar 

  26. Macdonald JS. Carcinoembryonic antigen screening: pros and cons. Semin Oncol. 1999;26:556–60.

    CAS  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dina Johar.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Consent to participate

Written consent to participate was given by all patients who were enrolled in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12029-018-0088-1

Keywords

Navigation