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Diagnostic Value of Fecal Calprotectin as a Screening Biomarker for Gastrointestinal Malignancies

  • Khoshbaten, Manouchehr (Liver and Gastroentestinal Disease Research Center, Tabriz University of Medical Sciences) ;
  • Pishahang, Parinaz (Liver and Gastroentestinal Disease Research Center, Tabriz University of Medical Sciences) ;
  • Nouri, Mohammad (Liver and Gastroentestinal Disease Research Center, Tabriz University of Medical Sciences) ;
  • Lashkari, Alireza (Liver and Gastroentestinal Disease Research Center, Tabriz University of Medical Sciences) ;
  • Alizadeh, Mahasti (Liver and Gastroentestinal Disease Research Center, Tabriz University of Medical Sciences) ;
  • Rostami-Nejad, Mohammad (Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Sciences)
  • Published : 2014.02.28

Abstract

Background: Calprotectin in feces seems to be a more sensitive marker for gastrointestinal (GI) cancers than fecal occult blood, but its specificity may be too low for screening average risk populations. This study aims at evaluating the diagnostic value of fecal calprotectin as a screening biomarker for GI malignancies. Materials and Methods: In a case-control study, 100 patients with GI malignancies (50 patients with colorectal cancer and 50 patients with gastric cancer) and 50 controls were recruited in Tabriz Imam Reza and Sina hospitals during a 24-month period. One to two weeks after the last endoscopy/colonoscopy, fecal specimens were collected by the patients and examined by ELISA method for quantitative measurement of calprotectin content. The results were compared between the three groups. Results: The mean fecal calprotectin level was $109.1{\pm}105.3$ (2.3-454.3, median:74), $241.1{\pm}205.2$ (3.4-610.0, median:19.3) and $45.9{\pm}55.1{\mu}g/g$ (1.3-257.1, median:19.3) in gastric cancer, colorectal cancer and control group, respectively, the differences being significant (p<0.001) and remaining after adjustment for age. The optimal cut-off point for fecal calprotectin was ${\geq}75.8{\mu}g/g$ for distinguishing colorectal cancer from normal cases (sensitivity and specificity of 80% and 84%, respectively). This value was ${\geq}41.9{\mu}g/g$ for distinguishing gastric cancer from normal cases (sensitivity and specificity of 62%). Conclusions: Our results revealed that fecal calprotectin might be a useful and non-invasive biomarker for distinguishing colorectal cancer from non-malignant GI conditions. However, due to low sensitivity and specificity, this biomarker may not help physicians distinguishing gastric cancer cases from healthy subjects.

Keywords

Colorectal cancer;gastric cancer;calprotectin;screening tool

References

  1. Stryker SJ, Wolff BG, Culp CE (1987). Natural history of untreated colonic polyps. Gastroenterology, 93, 1009-13. https://doi.org/10.1016/0016-5085(87)90563-4
  2. Somi MH, Farhang S, Mirinezhad SK, et al (2008). Cancer in East Azerbaijan, Iran: results of a population-based cancer registry. Asian Pac J Cancer Prev, 9, 327-30.
  3. Steinbakk M, Naess-Andresen CF, Lingaas E, et al (1990). Antimicrobial actions of calcium binding leucocyte L1 protein, calprotectin. Lancet, 336, 763-5. https://doi.org/10.1016/0140-6736(90)93237-J
  4. Striz I, Trebichavsky I (2004). Calprotectin; a pleiotropic molecule in acute and chronic inflammation. Physiol Res, 53, 245-53.
  5. Summerton CB, Longlands MG, Wiener K, et al (2002). Fecal calprotectin: a marker of inflammation throughout the intestinal tract. Eur J Gastroenterol Hepatol, 14, 841-45. https://doi.org/10.1097/00042737-200208000-00005
  6. Tibble J, Sigthorrson G, Foster R, et al (2001). Fecal calprotectin and fecal occult blood tests in the diagnosis of colorectal carcinoma and adenoma. Gut, 49, 402-8. https://doi.org/10.1136/gut.49.3.402
  7. von Roon AC, Karamountzos L, Purkayastha S, et al (2007). Diagnostic precision of fecal calprotectin for inflammatory bowel disease and colorectal malignancy. Am J Gastroenterol, 102, 803-13. https://doi.org/10.1111/j.1572-0241.2007.01126.x
  8. Norouzinia M, Asadzadeh H, Shalmani HM, et al (2012). Clinical and histological indicators of proximal and distal gastric cancer in eight provinces of Iran. Asian Pac J Cancer Prev, 13, 5677-9. https://doi.org/10.7314/APJCP.2012.13.11.5677
  9. Karl J, Wild N, Tacke M, et al (2008). Improved diagnosis of colorectal cancer using a combination of fecal occult blood and novel fecal protein markers. Clin Gastroenterol Hepatol, 6, 1122-8. https://doi.org/10.1016/j.cgh.2008.04.021
  10. Kronborg O, Ugstad M, Fuglerud P, et al (2000). Fecal calprotectin levels in a high risk population for colorectal neoplasia. Gut, 46, 795-800. https://doi.org/10.1136/gut.46.6.795
  11. Mohri Y, Inoue Y, Tanaka K, et al (2013). Prognostic nutritional index predicts postoperative outcome in colorectal cancer. World J Surg, 37, 2688-92 https://doi.org/10.1007/s00268-013-2156-9
  12. Ouyang DL, Chen JJ, Getzenberg RH, et al (2005). Noninvasive testing for colorectal cancer: a review. Am J Gastroenterol, 100, 1393-403. https://doi.org/10.1111/j.1572-0241.2005.41427.x
  13. Poullis A, Foster R, Mendall MA, et al (2003). Emerging role of calprotectin in gastroenterology. J Gastroenterol Hepatol, 18, 756-62. https://doi.org/10.1046/j.1440-1746.2003.03014.x
  14. Roseth AG, Kristinsson J, Fagerhol MK (1993). Fecal calprotectin: A novel test for the diagnosis of colorectal cancer? Scand J Gastroenterol, 28, 1073-76. https://doi.org/10.3109/00365529309098312
  15. Hoff G, Grotmol T, Thiis-Evensen E, et al (2004). Testing for fecal calprotectin (PhiCal) in the Norwegian Colorectal Cancer Prevention trial on flexible sigmoidoscopy screening: comparison with an immunochemical test for occult blood (FlexSure OBT). Gut, 53, 1329-33. https://doi.org/10.1136/gut.2004.039032
  16. Brydon WG, Campbell SS, Anderson NA (2001). Fecal calprotectin levels and colorectal neoplasia. Gut, 48, 579-80. https://doi.org/10.1136/gut.48.4.579
  17. Fagerberg UL, Loof L, Myrdal U, et al (2005). Colorectal inflammation is well predicted by fecal calprotectin in children with gastrointestinal symptoms. J Pediatr Gastroenterol Nutr, 40, 450-55. https://doi.org/10.1097/01.MPG.0000154657.08994.94
  18. Gebhardt C, Nemeth J, Angel P, et al (2006). S100A8 and S100A9 in inflammation and cancer. Biochem Pharmacol, 72, 1622-31. https://doi.org/10.1016/j.bcp.2006.05.017
  19. Johne B, Kronborg O, Ton HI, et al (2001). A new fecal calprotectin test for colorectal neoplasia. Clinical results and comparison with previous method. Scand J Gastroenterol, 36, 291-96. https://doi.org/10.1080/003655201750074618

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