| Background and objectives:Colorectal cancer is the fifth cause of cancer-related death in China,and there is an urgent need for simple and effective diagnostic methods to improve the prognosis of patients.Recently,some clinical blood indicators have been found to have diagnostic value for colorectal cancer,but there has no systematic evaluation.To this end,this study will retrospectively collect the data of commonly used clinical blood test indexes of hospitalized patients with colorectal cancer,colorectal adenoma and colorectal polyp,and systematically evaluate the diagnostic value of each index for colorectal cancer,especially early cancer.Then,a diagnostic model system was established to evaluate the combined diagnostic value of multiple indicators for colorectal cancer.Common clinical blood test indicators of colorectal cancer and colorectal adenoma patients were prospectively collected to verify the diagnostic value of single indicator and diagnostic model for colorectal cancer.At the same time,the serum level of trilobal factor-3(TFF3),which has recently been reported to be of good diagnostic value for colorectal cancer,was measured in prospective patients and its diagnostic value was evaluated.Methods:1.Diagnostic value of common blood test indexes in colorectal cancer:Clinical data of patients with colorectal cancer and adenoma/polyp hospitalized in the Third Affiliated Hospital of Nanchang University from March 2014 to July 2019 were retrospectively collected.The area under receiver operating characteristic curve(AUC)was used to evaluate the diagnostic value of various blood tests for colorectal cancer,including colorectal cancer in early stage.2.Diagnostic value of the model combined with common blood test indexes for colorectal cancer: Taking variables categories and all common blood test indexes as the independent variables in retrospective cases,multivariate binary logistic stepwise regression analysis was used to establish a diagnostic model system,and AUC was used to evaluate the diagnostic value of different types of multiple indicators combined for colorectal cancer,especially the value of early diagnosis,and internal verification was conducted.3.Prospective evaluation of the diagnostic value of common blood markers alone and in combination for colorectal cancer: Serum and clinical data of patients with colorectal cancer and adenoma hospitalized in the First Affiliated Hospital of Nanchang University from June 2020 to October 2020 were collected to supplement the missing blood test indicators,and the diagnostic value of single indicator and diagnostic model in retrospective analysis for colorectal cancer,including early colorectal cancer,was prospectively verified.4.The diagnostic value of trilobite factor 3(TFF3)in colorectal cancer:Serum TFF3 levels were measured by Enzyme-linked immunosorbent assay(ELISA)in the prospective patient group,and the diagnostic value of TFF3 and its model combined with clinical blood markers in colorectal cancer,early and advanced colorectal cancer were evaluated,respectively.Results1.Retrospective analysis of diagnostic value of common blood test indexes in colorectal cancer: A total of 505 patients were enrolled,including 210 cases of colorectal cancer,167 cases of colorectal adenoma,and 128 cases of colorectal polyp.A total of 76 blood test indicators were included in the analysis,among which 19 indicators had an AUC greater than 0.7,3 indicators had an AUC greater than 0.8,and5 indicators had an AUC greater than carcinoembryonic antigen(CEA).When the specificity was set at 90%,the overall sensitivity of 15 indicators was comparable to that of CEA,and the total sensitivity of 5 indicators was higher than that of CEA,but the difference was not statistically significant.Correlation analysis showed that these15 indicators had no or weak correlation with CEA.The AUC of eight indicators was greater than the CEA in differentiating colorectal cancer(TNM stage Ⅰ+Ⅱ)from colorectal adenoma/polyp.2.Retrospective analysis of the diagnostic value of common blood indicators combined with modeling for colorectal cancer: The blood cell analysis model,liver function index model and renal function index model all showed good value in the diagnosis of colorectal cancer,and the AUC was above 0.80.The value of blood lipid index model(AUC 0.748)was slightly lower than that of CEA(AUC0.757)in the diagnosis of colorectal cancer.The diagnostic efficiency of blood glucose index model(AUC 0.795)and blood coagulation function index model(AUC0.779)were similar to that of CEA.The AUC of the whole blood index model for the diagnosis of colorectal cancer was 0.918,and it also had good diagnostic value for early colorectal cancer(AUC 0.929).The sensitivity,specificity and accuracy were83.3%,91.1% and 87.7%,respectively.In addition,the AUC of the whole blood index model for early colorectal cancer diagnosis was 0.921.3.Prospective evaluation of the diagnostic value of common blood markers alone and in combination for colorectal cancer: The prospective patient group included 97 colorectal cancer patients and 154 colorectal adenomas(76 of which were advanced adenomas).There were 10 single blood indicators greater than 0.7,among which 8 were of diagnostic value for early colorectal cancer(stage Ⅰ+Ⅱ),all of which were better than CEA.Among these indicators,5 were similar to the results of the retrospective analysis.The AUC of the full-index model for colorectal cancer diagnosis in prospective cases was 0.665,and that of early colorectal cancer was0.655,which was not ideal.The diagnostic model was optimized by considering the indicators with diagnostic value in both the retrospective case group and the prospective case group.The AUC of the optimized model for all indicators in the prospective case group,the early case group and the advanced case group were 0.827,0.807 and 0.824,respectively,showing good diagnostic value.4.Diagnostic value of trilobal factor(TFF3)in colorectal cancer: The serum TFF3 level was significantly higher in colorectal cancer patients than in colorectal adenoma patients,and the difference between stage Ⅰ+Ⅱ and stage Ⅲ+Ⅳ colorectal cancer patients was not statistically significant.The AUC of TFF3 in distinguishing colorectal cancer from adenoma,stage Ⅰ+Ⅱ colorectal cancer from adenoma,and stage Ⅰ+Ⅱ colorectal cancer from advanced adenoma were all about 0.75.The AUC of TFF3 combined with clinical blood indicators in the diagnosis model of colorectal cancer,early colorectal cancer and adenoma,and advanced adenoma reached about0.85,which was significantly improved compared with TFF3 and CEA alone.Conclusions:1.The value of common clinical blood test in differentiating colorectal cancer from colorectal adenoma/polyp group was systematically reviewed.Most of the indicators were found to have certain diagnostic value for colorectal cancer,including early colorectal cancer,and many of them were superior to or comparable to the diagnosis of CEA.2.The diagnostic models were established according to the categories of commonly used blood indexes,which had better diagnostic value for colorectal cancer,and were superior to CEA except for the blood lipid indexes model.A full-index model based on 6 blood markers has good diagnostic value for colorectal cancer,including early colorectal cancer.3.In prospective case validation analyses,the diagnostic value of only part of individual indicators for colorectal cancer was verified.The full-index diagnostic model for colorectal cancer was also less effective in the prospective case group,However,all the optimized index models showed good diagnostic value for colorectal cancer,including early colorectal cancer,in validation analysis.4.Serum TFF3 alone has a better diagnostic value for colorectal cancer,and the diagnostic model combined with three clinical blood markers(prealbumin,cholinesterase,and ferritin)can further improve the ability to distinguish colorectal cancer from adenoma,and early colorectal cancer from adenoma.TFF3 as a diagnostic marker of colorectal cancer deserves further study. |
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