Establishment of Molecular Classification Models for Early Diagnosis of Digestive System Cancers

This is a single blind, case control, multicenter study jointly developed by Zhongshan Hospital of Fudan University, Shanghai Public Health Clinical Center, Shanghai Xuhui Central Hospital, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, and Shanghai Singlera Genomics Company. The enrolled population will include positive group, precancerous lesions and healthy control group, which is expected to enroll 2,430 participants. The primary objective is to establish molecular testing methods for non-invasive screening and early diagnosis of digestive system cancers through ctDNA methylation and mutation, cfDNA and ctDNA fragment size, and end motif based model (for esophageal, gastric, colorectal cancer), and through ctDNA methylation detection, ctDNA low-pass WGS, miRNA7 and CTC detection and analysis technology based model (for hepatocellular carcinoma). The sensitivity and specificity of the models in cancer early detection will be evaluated.

Study Overview

• Status: Completed
• Conditions: Hepatocellular Carcinoma; Colorectal Cancer; Esophageal Cancer; Gastric (Stomach) Cancer

Detailed Description

Design of the project: 1) Participants who sign informed consent forms will complete the disease history information collection;2) Collect samples of cancer tissue and corresponding paracancer samples, as well as peripheral blood; 3) Using the MONOD patent detection data of the company's previous research and combining with literature retrieval, to analyze the tissue samples of digestive system cancers to screen the methylation mutation sites;4) ctDNA methylation markers are preliminarily screened by plasma of healthy persons paired with tissues;5) Using the screened blood ctDNA specific methylation markers together with other molecular markers to establish a targeted detection method for early digestive system cancer lesions;6) Retain the most distinguishing targets in the original panel test and establish the second version of the panel;7) Establish and validate predictive models to finalize multitype molecular target detection for peripheral blood DNA;8) Construct statistical learning models based on ctDNA methylation and fragment features, miRNA7™ and CTC, and optimize the models respectively;9) Evaluate the sensitivity and specificity of the models in cancer early detection.

• Study Type: Observational
• Enrollment (Actual): 2430

Contacts and Locations

• Study Contact: Name: Xinrong Yang, Doctor; Phone Number: 18616881978; Email: yang.xinrong@zs-hospital.sh.cn
• Study Contact Backup: Name: Rui Liu, Doctor; Email: rliu@singleragenomics.com

Study Locations

• China
  • Shanghai
    • Shanghai, Shanghai, China, 201500
      • Shanghai Public Health Clinical Center
    • Shanghai, Shanghai, China, 200030
      • Xuhui Central Hospital, Shanghai
    • Shanghai, Shanghai, China, 200030
      • Zhongshan Hospital of Fudan University
    • Shanghai, Shanghai, China, 201700
      • Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

This study aims to enroll 2430 participants from Zhongshan Hospital, Xuhui central hospitial, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University and Shanghai Public Health Clinical Center.

Description

Colorectal cancer, Esophageal cancer and Gastric (stomach) cancer Group

Inclusion Criteria:

1. Aged 18 to 80, no gender limitation, no pregnant or breastfeeding for women;
2. Those who can accept gastroscopy and/or total colonoscopy;
3. Newly-diagnosed patients who had not received surgery, radiotherapy, chemotherapy, targeted therapy or other anti-tumor intervention;
4. Stop anticoagulant drugs such as warfarin, aspirin, and bolivir for 1 week, and stop low molecular weight heparin that day;
5. No previous history of other tumor diseases, and no abnormalities in the liver and kidney;
6. No major trauma requiring blood transfusion treatment within one week.

Exclusion Criteria:

1. Previous esophageal cancer, stomach cancer, bowel cancer and gastrointestinal adenoma;
2. Have a history of other cancers;
3. Systemic inflammatory response syndrome;
4. Previously experienced esophageal, gastric or colorectal adenoma removal or tumor resection;
5. Patients with Lynch syndrome in the family;
6. A history of severe cardiovascular disease (e.g., previous myocardial infarction, coronary artery bypass grafting, coronary stenting, congestive heart failure, myocardial infarction within 6 months, or uncontrolled severe hypertension, etc.) who were deemed unsuitable for inclusion by the investigator;
7. Have participated in an "interventional" clinical trial within the past 30 days and have taken the experimental drug;
8. Unsuitable for this trial determined by the researchers;
9. Failure to collect blood on time according to plan;
10. The blood sample does not meet the requirements.

Hepatocellular Carcinoma Group

Inclusion Criteria:

1. Applicable to all enrolled volunteers (1) Aged 18 to 80, no gender limitation, no pregnant or breastfeeding for women; (2) No previous history of malignancy in other sites; (3) To avoid the risk of bleeding caused by taking anticoagulants during sampling, the following provisions shall be made according to different types of samples: stop anticoagulant drugs such as warfarin, aspirin, and bolivir for 1 week, and stop low molecular weight heparin that day; the doctor in charge decides whether to stop anticoagulant drugs before blood draw, according to the specific situation of the volunteers, ; (4) No major trauma requiring blood transfusion treatment within one week;
2. Only for patients with hepatocellular carcinoma (HCC). (1) Diagnosed with stage I-IV hepatocellular carcinoma; (2) Newly-diagnosed patients with liver cancer, who had not received surgery, radiotherapy, chemotherapy, targeted therapy or other anti-tumor intervention;
3. Only for high-risk groups (1) Diagnosis of child-Pugh grade A or B, chronic hepatitis B or cirrhosis; (2) No history of liver cancer or malignancy in other sites;
4. For healthy people only (1) Normal liver function test results on the day of blood collection; (2) No history of hepatitis B, hepatitis C and cirrhosis; (3) No history of liver cancer or malignancy in other sites.

Exclusion Criteria:

1. Patients with liver cancer who have received surgery, radiotherapy, chemotherapy, targeted therapy;
2. Cancer patients except HCC, or patients with liver metastasis;
3. Systemic inflammatory response syndrome;
4. A history of severe cardiovascular disease (e.g., previous myocardial infarction, coronary artery bypass grafting, coronary stenting, congestive heart failure, myocardial infarction within 6 months, or uncontrolled severe hypertension, etc.) who were deemed unsuitable for inclusion by the investigator;
5. Have participated in an "interventional" clinical trial within the past 30 days and have taken the experimental drug;
6. Unsuitable for this trial determined by the researchers;
7. Failure to collect blood on time according to plan;
8. The blood sample does not meet the requirements.

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Control
• Time Perspectives: Cross-Sectional

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort
Digestive system cancer group; A total of about 1035 cases are expected to be enrolled, including 432 cases in stage I and 603 cases in II-IV.
Negative group; 985 healthy individuals.
High risk group; 410 cases with precancerous diseases.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Establish ctDNA-targeted sequencing models for early detection of esophageal, gastric, colorectal and hepatocellular cancer, and evaluate the diagnosis value	To discover the characteristic targets of ctDNA methylation, fragment, and mutation in esophageal, gastric, colorectal cancers, and hepatocellular carcinoma, and establish the early detection panel. Then, evaluate the sensitivity and specificity of multi-cancer early detection models.	assessed up to 1 year
Establish and evaluate the non-invasive early detection model for hepatocellular carcinoma	To establish and evaluate the early detection model for hepatocellular carcinoma based on ctDNA methylation detection, ctDNA low-pass WGS, miRNA7™ and CTC detection.	assessed up to 1 year

Collaborators and Investigators

• Sponsor: Singlera Genomics Inc.
• Collaborators: Fudan University; Shanghai Zhongshan Hospital; Shanghai Public Health Clinical Center; Xuhui Central Hospital, Shanghai
• Investigators: Study Director: Jian Zhou, Doctor, Fudan University; Study Director: Yunshi Zhong, Doctor, Fudan University; Study Director: Bin Yan, Doctor, Shanghai Zhongshan Hospital; Study Director: Dongli He, Master, Xuhui Central Hospital, Shanghai; Principal Investigator: Rui Liu, Doctor, Singlera Genomics Inc.

Publications and helpful links

General Publications

• Guo S, Diep D, Plongthongkum N, Fung HL, Zhang K, Zhang K. Identification of methylation haplotype blocks aids in deconvolution of heterogeneous tissue samples and tumor tissue-of-origin mapping from plasma DNA. Nat Genet. 2017 Apr;49(4):635-642. doi: 10.1038/ng.3805. Epub 2017 Mar 6.
• Chen X, Gole J, Gore A, He Q, Lu M, Min J, Yuan Z, Yang X, Jiang Y, Zhang T, Suo C, Li X, Cheng L, Zhang Z, Niu H, Li Z, Xie Z, Shi H, Zhang X, Fan M, Wang X, Yang Y, Dang J, McConnell C, Zhang J, Wang J, Yu S, Ye W, Gao Y, Zhang K, Liu R, Jin L. Non-invasive early detection of cancer four years before conventional diagnosis using a blood test. Nat Commun. 2020 Jul 21;11(1):3475. doi: 10.1038/s41467-020-17316-z.

Study record dates

Study Major Dates

• Study Start (Actual): November 15, 2020
• Primary Completion (Actual): June 30, 2023
• Study Completion (Actual): July 31, 2023

Study Registration Dates

• First Submitted: June 19, 2022
• First Submitted That Met QC Criteria: June 19, 2022
• First Posted (Actual): June 24, 2022

Study Record Updates

• Last Update Posted (Actual): April 17, 2024
• Last Update Submitted That Met QC Criteria: April 15, 2024
• Last Verified: January 1, 2023

More Information

Terms related to this study

• Keywords: miRNA; DNA methylation; CTC; ctDNA markers; DNA fragment feature; Cancer early detection
• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms; Neoplasms by Site; Gastrointestinal Neoplasms; Gastrointestinal Diseases; Stomach Diseases; Stomach Neoplasms; Digestive System Neoplasms
• Other Study ID Numbers: 2019YFC1315802-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No