文章：

在平均风险患者初次筛查结肠镜检查中，基于血液生物标志物在结直肠肿瘤预测中的应用：系统性文献综述

The Use of Blood-Based Biomarkers in the Prediction of Colorectal Neoplasia at the Time of Primary Screening Colonoscopy Among Average-Risk Patients: A Systematic Literature Review

原文发布日期：14 November 2024

DOI: 10.3390/cancers16223824

类型: Article

开放获取: 是

英文摘要：

Background/Objectives: Risk prediction models (RPMs) for colorectal cancer (CRC) could facilitate risk-based screening. Models incorporating biomarkers may improve the utility of current RPMs. We performed a systematic review of studies reporting RPMs for CRC that evaluated the impact of blood-based biomarkers on clinical outcome prediction at the time of screening colonoscopy in average-risk populations. Methods: We conducted a search of MEDLINE, Web of Science, and PubMed databases from inception through April 2024. Studies that developed or validated a model to predict risk of CRC or its precursors were included. Studies were limited to those including patients undergoing average-risk CRC screening. Results: Sixteen studies published between 2015 and 2024 were included. Outcomes included CRC (16 studies) and high-risk adenomas (1 study). Using a complete blood count was the most common biomarker and was able to achieve an AUC of 0.82 and a specificity of 0.88. Other blood-based biomarkers included were various serum proteins/metabolites/enzymes, plasma metabolites, insulin-related factors, and anemia markers. The highest-performing model, with an AUC of 0.99, involved the use of a plasma metabolite panel. Conclusions: The evidence base of RPMs for CRC screening is expanding and incorporating biomarkers, which remain a prominent aspect of model discovery. Most RPMs included a lack of internal/external validation or discussion as to how the model could be implemented clinically. As biomarkers improve the discriminatory potential of RPMs, more research is needed for the evaluation and implementation of RPMs within existing CRC screening frameworks.

摘要翻译： 

背景/目的：结直肠癌风险预测模型有助于实施基于风险的筛查。整合生物标志物的模型可提升现有风险预测模型的实用性。本研究系统综述了针对平均风险人群在筛查性结肠镜检查时，评估血液生物标志物对临床结局预测影响的结直肠癌风险预测模型研究。方法：系统检索自建库至2024年4月期间MEDLINE、Web of Science和PubMed数据库。纳入标准为开发或验证结直肠癌或其癌前病变风险预测模型的研究，且研究对象限定为接受平均风险结直肠癌筛查的患者。结果：共纳入2015年至2024年间发表的16项研究。预测结局包括结直肠癌（16项研究）和高风险腺瘤（1项研究）。全血细胞计数是最常用的生物标志物，其受试者工作特征曲线下面积可达0.82，特异性达0.88。其他纳入的血液生物标志物包括各类血清蛋白/代谢物/酶、血浆代谢物、胰岛素相关因子及贫血标志物。性能最优的模型采用血浆代谢物组合，其受试者工作特征曲线下面积达0.99。结论：结直肠癌筛查风险预测模型的证据体系正在扩展，生物标志物整合仍是模型开发的重要方向。多数模型缺乏内部/外部验证，亦未探讨临床实施路径。虽然生物标志物提升了风险预测模型的鉴别能力，但如何在现有结直肠癌筛查框架中评估和实施这些模型仍需进一步研究。

原文链接：

The Use of Blood-Based Biomarkers in the Prediction of Colorectal Neoplasia at the Time of Primary Screening Colonoscopy Among Average-Risk Patients: A Systematic Literature Review