文章：

结直肠癌筛查：粪便分子分析的前景

Colorectal cancer screening: prospects for molecular stool analysis

原文发布日期：2005-03-01

DOI: 10.1038/nrc1569

类型: Review Article

开放获取: 否

要点：

1. Colorectal cancer (CRC) is amenable to screening: it has a recognizable early stage and a defined natural history; surgical treatment of malignancy is effective; and pre-malignant lesions can be removed if detected. However, it is not yet clear whether screening should target early cancers or pre-malignant adenomas.
2. Current screening tests either detect the presence of blood in stool (faecal occult blood testing) or identify gross abnormalities (for example, flexible sigmoidoscopy and colonoscopy). All current tests are limited in patient acceptability and/or effectiveness.
3. There are prospects for new screening tests based on increased understanding of the biology and natural history of CRC. There is considerable interest in stool testing, which is non-invasive; does not require bowel preparation; potentially enables screening of the entire length of the colon and rectum; and produces specimens that are transportable.
4. One category of stool test involves detecting cells or cell contents in stool, for which colonocytes are likely to be a better target than blood. Biomarkers such as minichromosome maintenance proteins could indicate the presence of CRC cells in stool and/or facilitate the identification of such cells following colonocyte isolation.
5. An alternative approach involves testing for abnormal DNA in stool, using target genes identified as being abnormal in the colorectal adenoma–carcinoma sequence. Individual DNA tests generally have high specificity but low sensitivity, so multitarget DNA assays have been developed.
6. Large-scale evaluation of candidate tests, either singly or in combination, is now required. Of particular value would be randomized controlled trials showing a reduction in CRC incidence and/or mortality in the tested individuals.
7. An effective screening strategy would produce extra health-care provision costs, although these would be balanced by a reduced requirement to treat patients with established CRC. 'Halo effects' of an effective screening test would produce benefits for patients with symptomatic CRC as well as the screened population.

要点翻译：

1. 结直肠癌（CRC）适合进行筛查：它具有可识别的早期阶段和明确的自然病程；恶性肿瘤的手术治疗有效；若发现癌前病变可予以切除。然而，筛查应以早期癌症还是癌前腺瘤为目标尚未明确。
2. 现有筛查手段要么检测粪便中是否存在血液（粪便潜血试验），要么识别大体异常（如软式乙状结肠镜和结肠镜检查）。所有现行检测方法在患者接受度和/或有效性方面均存在局限性。
3. 基于对CRC生物学和自然史认识的深入，新型筛查技术前景可期。无创性粪便检测备受关注：它无需肠道准备；可能实现对全结肠和直肠的筛查；且样本便于运输。
4. 一类粪便检测涉及识别粪便中的细胞或细胞成分，其中结肠细胞可能是比血液更理想的目标。微小染色体维持蛋白等生物标志物可提示粪便中CRC细胞的存在，和/或有助于结肠细胞分离后对此类细胞的鉴定。
5. 另一种方法是通过检测粪便中异常DNA进行筛查，所用靶基因已被证实存在于结直肠腺瘤-癌变序列中。单项DNA检测通常特异性高但敏感性不足，因此多靶点DNA检测技术得以发展。
6. 目前需要对候选检测方法（单独或联合应用）进行大规模评估。尤其有价值的是能证明受试者CRC发病率和/或死亡率降低的随机对照试验。
7. 有效的筛查策略将产生额外的医疗成本，但这会被晚期CRC患者治疗需求的减少所抵消。有效筛查手段的"光环效应"将使有症状的CRC患者和筛查人群共同获益。

英文摘要：

Colorectal cancer is common. As many patients present with advanced disease, an effective screening test would have substantial clinical benefits. Recent progress in understanding the biology of colorectal cancer (and of cancer cells in general) has led to possible new approaches to screening. In particular, there are prospects of developing tests based on analysis of stool, which promise improved accuracy, safety, affordability and patient compliance.

摘要翻译： 

结直肠癌很常见。由于许多患者初诊时已属晚期，因此有效的筛查方法将带来显著的临床获益。近年来，对结直肠癌（以及癌细胞总体）生物学认识的进展，催生了新的筛查思路。特别是基于粪便分析的检测方法有望提高准确性、安全性、可负担性和患者依从性。

原文链接：

Colorectal cancer screening: prospects for molecular stool analysis