Précision diagnostique d'un panel de marqueurs génétiques bactériens (M3) pour la néoplasie colorectale avancée (M3-PRO)
Une étude transversale prospective pour évaluer la précision diagnostique d'un panel de marqueurs génétiques bactériens (M3) pour la néoplasie colorectale avancée
The investigators aim to evaluate and compare the diagnostic accuracy of FIT and the novel panel of bacterial gene markers (Fn, m3, Ch and Bc) collectively named as M3, in detecting colorectal advanced neoplasia.
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
Colorectal cancer (CRC) is the one of the most common cancers in Hong Kong with more than 5,500 new cases annually. There is prevailing evidence of increasing trend of young onset CRC globally. Early detection and resection of pre-malignant colorectal neoplasia has shown to reduce CRC-related mortality.
Non-invasive stool tests including guaiac-based faecal occult blood tests (gFOBT) and faecal immunochemical tests (FIT) are the cornerstones of population-based CRC screening programmes. The major limitation of this widely used strategy is its unsatisfactory sensitivities for CRC (79%) and advanced adenomas (AA; 40%). The sensitivity for non-advanced adenomas is even lower than 10%. A large proportion of advanced and non-advanced adenomas will be missed by FIT alone. Therefore, identification of alternative non-invasive test with better sensitivity to detect colorectal neoplasia is warranted.
Multitarget stool DNA test and faecal microbial DNA markers appear to be promising options for CRC screening. Several bacterial gene markers have been identified by metagenome sequencing and reported to be associated with CRC, including Fusobacterium nucleatum (Fn), Clostridium hathewayi (Ch) and Bacteroides clarus (Bc). However, these molecular markers had low accuracy in distinguishing adenomas from normal tissue. Recently, a new Lachnoclostridium gene marker (labelled as 'm3') has been shown to have high diagnostic yield for the detection of colorectal adenomas. In a case-control study of 1012 subjects, a linear increasing trend of m3 level was observed from fecal samples of healthy subjects to those with adenomas and cancers. The overall sensitivity of m3 was significantly higher than FIT in detecting all adenomas (48% vs 9.3%), AA (50.8% vs 16.1%) and non-advanced adenomas (44.2% vs 0%). The diagnostic accuracy of m3 could be further enhanced by combining with a panel of fecal microbial markers composing of Fusobacterium nucleatum (Fn), Bacteroides clarus (Bc), Clostridium hathewayi (Ch) for CRC (82.3%) and adenomas (64.2%). We hypothesized that the combination of these 4 bacterial gene markers (known as M3) is more sensitive than FIT in detecting colorectal advanced neoplasia.
Type d'étude
Inscription (Estimé)
Contacts et emplacements
Lieux d'étude
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-
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Hong Kong, Hong Kong
- Prince of Wales Hospital
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-
Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
Méthode d'échantillonnage
Population étudiée
Subjects with average risk of colorectal neoplsia requring screening/surveillance colonoscopy
La description
Inclusion Criteria:
- They require elective colonoscopy for colorectal cancer screening or polyp surveillance, or investigation of symptoms (e.g. anemia, change of bowel habit, abdominal pain);
- Aged ≥18 years old;
- Written informed consent obtained.
Exclusion Criteria:
- Contraindications to colonoscopy (e.g. perforation, intestinal obstruction, unstable cardiopulmonary status);
- Contraindication to polyp resection (e.g. active gastrointestinal bleeding, uninterrupted anticoagulation or dual antiplatelets);
- Known colorectal cancer or adenoma for staged procedure;
- Previous colonic resection;
- Personal history of colorectal cancer;
- Personal history of polyposis syndrome;
- Personal history of inflammatory bowel disease;
- Known pregnancy or lactation;
- Advanced comorbid conditions (defined as American Society of Anesthesiologists grade 4 or above);
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Modèles d'observation: CASE_ONLY
- Perspectives temporelles: CROSS_SECTIONAL
Cohortes et interventions
Groupe / Cohorte |
Intervention / Traitement |
|---|---|
|
Colorectal neoplasia screening/surveillance cohort
Subjects with average risk of colorectal neoplasias requiring screening/surveillance colonoscopy |
A kind of stool test
Autres noms:
|
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Sensitivity of bacterial gene markers panel (M3)
Délai: 1 month
|
The proportion of subjects with true positive results of M3 among those with one of more advanced neoplasia detected in the index colonoscopy. |
1 month
|
|
Sensitivity of FIT/FOBT
Délai: 1 month
|
The proportion of subjects with true positive results of FIT among those with one of more advanced neoplasia detected in the index colonoscopy. |
1 month
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Sensitivity of M3 for early-stage (stage 1) or invasive (stage 2-4) colorectal cancers
Délai: 1 month
|
The proportion of subjects with true positive results of M3 among those with early-stage (stage 1) or invasive (stage 2-4) colorectal cancers detected in the index colonoscopy. |
1 month
|
|
Sensitivity of FIT/FOBT for early-stage (stage 1) or invasive (stage 2-4) colorectal cancers
Délai: 1 month
|
The proportion of subjects with true positive results of FIT among those with early-stage (stage 1) or invasive (stage 2-4) colorectal cancers detected in the index colonoscopy. |
1 month
|
|
Sensitivity of FIT/FOBT for advanced adenomas
Délai: 1 month
|
The proportion of subjects with true positive results of FIT among those with one or more advanced adenomas detected in the index colonoscopy. |
1 month
|
|
Sensitivity of M3 for advanced adenomas
Délai: 1 month
|
The proportion of subjects with true positive results of M3 among those with one or more advanced adenomas detected in the index colonoscopy. |
1 month
|
|
Sensitivity of FIT/FOBT for all adenomas
Délai: 1 month
|
The proportion of subjects with true positive results of FIT among those with all advanced adenomas detected in the index colonoscopy. |
1 month
|
|
Sensitivity of M3 for all adenomas
Délai: 1 month
|
The proportion of subjects with true positive results of M3 among those with all advanced adenomas detected in the index colonoscopy. |
1 month
|
|
Sensitivity of FIT/FOBT for sessile serrated lesions (SSL)
Délai: 1 month
|
The proportion of subjects with true positive results of FIT among those with SSLs detected in the index colonoscopy. |
1 month
|
|
Sensitivity of M3 for sessile serrated lesions (SSL)
Délai: 1 month
|
The proportion of subjects with true positive results of M3 among those with SSLs detected in the index colonoscopy. |
1 month
|
|
Specificity
Délai: 1 month
|
The proportion of true negative results of M3/FOBT/FIT among those with no adenoma detected in colonoscopy |
1 month
|
|
Positive predictive value (PPV)
Délai: 1 month
|
The ratio of subjects truly diagnosed as positive to all those who had positive test results |
1 month
|
|
Negative predictive value (NPV)
Délai: 1 month
|
The ratio of subjects truly diagnosed as negative to all those who had negative test results |
1 month
|
|
Overall diagnostic accuracy
Délai: 1 month
|
The proportion of correctly classified subjects among all subjects |
1 month
|
|
Microbiota changes in subjects with adenomas or normal findings after polypectomy
Délai: 1 month
|
Microbiota change measured by qPCR or metagenomic sequencing |
1 month
|
Collaborateurs et enquêteurs
Parrainer
Collaborateurs
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Réel)
Achèvement primaire (Réel)
Achèvement de l'étude (Estimé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- 2022.170
Plan pour les données individuelles des participants (IPD)
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Informations sur les médicaments et les dispositifs, documents d'étude
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