Colorectal cancer screening: Comparison of transferrin and immuno fecal occult blood test

Chen, Jigui; Cai, Juan; Wu, Huanlei; Xu, Hua; Zhang, Yuxing; Chen, Chao; Wang, Qian; Xu, Jun; Yuan, Xianglin

doi:10.3748/wjg.v18.i21.2682

Cited by 16 publications

(14 citation statements)

References 33 publications

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“…Previous studies from China [14][15][16] presented similar diagnostic performance of fecal hemoglobin and transferrin among symptomatic individuals at increased risk. In all three studies the combination of both markers led to an increase of sensitivity for CRC from 75% to 90%, 14 from 96% to 100%, 15 and from 57% to 86%, 16 respectively, but this went along with a similarly strong reduction of specificity from 88% to 71%, 14 from 72% to 61%, 15 and from 59% to 38%, 16 respectively. Because no AUCs were calculated, it was unclear whether the combination of both markers is able to improve the overall test performance, especially among average-risk screening participants.…”

Section: Discussionmentioning

confidence: 76%

“…13 Previous studies suggested that combining FITs for hemoglobin with fecal transferrin might increase sensitivity among symptomatic individuals. [14][15][16] For example, Sheng et al reported an increase of sensitivity for CRC and advanced adenoma (AA) from 75% to 90% and from 44% to 78%, respectively. 14 Transferrin is an iron-binding blood plasma protein that is released together with hemoglobin through bleeding into the digestive tract.…”

Section: Introductionmentioning

confidence: 99%

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Fecal immunochemical test for hemoglobin in combination with fecal transferrin in colorectal cancer screening

et al. 2018

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Objective Fecal transferrin has been suggested as a complementary or even superior marker for early detection of colorectal cancer (CRC) besides fecal hemoglobin. We aimed to evaluate both markers individually and in combination in a large cohort of participants of screening colonoscopy. Methods Precolonoscopy stool samples were obtained from participants of screening colonoscopy and frozen at −80℃ until blinded analysis, using a dual-quantitative fecal immunochemical test (FIT) for hemoglobin and transferrin. Sensitivity, specificity and area under the curve (AUC) were calculated for CRC and advanced adenoma (AA). Results A total of 1667 participants fulfilled our inclusion criteria. All individuals with advanced neoplasm (AN) (16 CRC, 200 AA) and 300 randomly selected participants without AN were included. Mean age was 63 years and 56% were male. The AUC for CRC and AA was 92% and 68%, respectively, for hemoglobin vs. 79% and 58%, respectively for transferrin. Combination of both markers yielded an AUC for CRC and AA of 92% and 68%, respectively. Conclusion FIT for hemoglobin shows better diagnostic performance than FIT for transferrin for the detection of ANs (both proximal and distal neoplasms), and a combination of both markers does not improve the diagnostic performance.

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Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Fecal immunochemical test for hemoglobin in combination with fecal transferrin in colorectal cancer screening

et al. 2018

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“…Transferrin (Tf), which is mainly responsible for the transport of iron in the blood, has also been identified as a potential biomarker for CRC [14] , [15] . Bleeding into the gastrointestinal tract releases both Tf and Hb into feces where it can be measured by immunoassay-based tests [15] , [16] , [17] , [18] . Furthermore, it has been reported from in vitro studies [15] , and implied from studies done on CRC screening populations [17] , that Hb is more sensitive to degradation by enterobacteria and digestive enzymes than Tf.…”

Section: Introductionmentioning

confidence: 99%

“…Bleeding into the gastrointestinal tract releases both Tf and Hb into feces where it can be measured by immunoassay-based tests [15] , [16] , [17] , [18] . Furthermore, it has been reported from in vitro studies [15] , and implied from studies done on CRC screening populations [17] , that Hb is more sensitive to degradation by enterobacteria and digestive enzymes than Tf. While the original source of data substantiating the latter claim is not clear, it has been hypothesized that increased time in the bowel due to constipation or bleeding from lesions located further up the bowel in the ascending colon may yield false negative results when Hb is used alone as a screening biomarker.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the fact that the relative recovery of Hb from feces is only about 5 times higher than that of Tf, while blood concentrations of Hb is approximately 100 fold higher than Tf [16] , also suggests greater stability of Tf in the fecal matrix. Recently, combining Tf with Hb as fecal CRC biomarkers had shown to produce higher positivity rates in patients with cancer or premalignant lesions [14] , [16] , [17] , [18] .…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the analytical performance of the novel NS-Prime system and examination of temperature stability of fecal transferrin compared with fecal hemoglobin as biomarkers in a colon cancer screening program

Demian

Collins²,

Fowler³

et al. 2015

Practical Laboratory Medicine

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ObjectiveTo examine the analytical aspects of fecal transferrin (Tf) and hemoglobin (Hb) measured on the NS-Prime analyzer for use in a colon cancer screening program.Designs and methodsMethod evaluation and temperature stability studies for fecal Tf and Hb were completed. A method comparison was carried out against the NS-Plus system using samples collected from 254 screening program participants. A further 200 samples were analyzed to help determine suitable reference limits for fecal Tf using these systems.ResultsThe assay for fecal Tf showed acceptable linearity, precision, and recovery, and showed minimal carryover with low potential for impact by the prozone effect. The 95th percentile for fecal Tf obtained for the reference population was 4.9 µg/g feces. The collection device sufficiently maintained fecal Tf and Hb stability for at least 7 days at room temperature, 4 °C, and −20 °C. Fecal Tf and Hb were most stable at 4 °C and −20 °C, but showed considerable loss (20–40%) of both proteins at 37 °C within the first 7 days. Mixing small amounts of blood into diluted fecal samples maintained at 37 °C for various time periods showed >50% loss of both proteins within 1 h of incubation.ConclusionsThe NS-Prime analyzer showed acceptable performance for fecal Tf and Hb. These studies suggest that use of both Tf and Hb together as biomarkers will result in higher positivity rates, but this may not be attributed to greater stability of Tf over Hb in human feces.

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A network‐based predictive gene expression signature for recurrence risks in stage II colorectal cancer

Yang

Wang

et al. 2019

Cancer Medicine

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The current criteria for defining the recurrence risks of stage II colorectal cancer (CRC) are not robust; therefore, we aimed to explore novel gene signatures to predict recurrence risks and to reveal the underlying mechanisms of stage II CRC. First, the gene expression profiles of 124 patients with stage II CRC from The Cancer Genome Atlas (TCGA) database were obtained to screen differentially expressed genes (DEGs). A total of 202 DEGs, including 128 upregulated and 74 downregulated, were identified in the recurrence group (n = 24) compared to the nonrecurrence group (n = 100). Furthermore, the top 5 DEGs (ZNF561, WFS1, SLC2A1, MFI2, and PTGR1) were identified by random forest variable hunting, and four (ZNF561, WFS1, SLC2A1, and PTGR1) were selected to create a four‐gene recurrent model (GRM), with an area under the curve (AUC) of 0.882 according to the receiver operating characteristic curve, and the robust diagnostic effectiveness of the GRM was further validated with another gene expression profiling dataset (GSE12032), with an AUC of 0.943. The diagnostic effectiveness of the GRM regarding recurrence was associated with poor disease‐free survival in all stages of CRC. In addition, gene ontology functional annotation and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses revealed 18 enriched functions and 6 enriched pathways. Four genes, ABCG2, CACNA1F, CYP19A1, and TF, were identified as hub genes by the protein‐protein interaction network, which further validated that these genes were correlated with a poor pathologic stage and overall survival in all stages of CRC. In conclusion, the GRM can effectively classify stage II CRC into groups of high and low risks of recurrence, thereby making up for the prognostic value of the traditional clinicopathological risk factors defined by the National Comprehensive Cancer Network guidelines. The hub genes may be useful therapeutic targets for recurrence. Thus, the GRM and hub genes could offer clinical value in directing individualized and precision therapeutic regimens for stage II CRC patients.

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Colorectal cancer screening: Comparison of transferrin and immuno fecal occult blood test

Abstract: Tf dipstick test might be used as an additional tool for CRC and precancerous lesions screening in a high-risk cohort.

Cited by 16 publications

References 33 publications

Fecal immunochemical test for hemoglobin in combination with fecal transferrin in colorectal cancer screening

Fecal immunochemical test for hemoglobin in combination with fecal transferrin in colorectal cancer screening

Evaluation of the analytical performance of the novel NS-Prime system and examination of temperature stability of fecal transferrin compared with fecal hemoglobin as biomarkers in a colon cancer screening program

A network‐based predictive gene expression signature for recurrence risks in stage II colorectal cancer

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