Robust performance of a novel stool DNA test of methylated SDC2 for colorectal cancer detection: a multicenter clinical study

Jianping Wang, Side Liu, Hui Wang, Lei Zheng, Changchun Zhou, Guoxin Li, Rongkang Huang, Huaiming Wang, Chujun Li, Xinjuan Fan, Xinhui Fu, Xinying Wang, Hongliang Guo, Jie Guan, Yanlai Sun, Xilin Song, Zengjun Li, Dianbin Mu, Jujie Sun, Xianglin Liu, Yan Qi, Feng Niu, Chunhua Chen, Xiaolin Wu, Xianshu Wang, Xianrang Song, Hongzhi Zou, Jianping Wang, Side Liu, Hui Wang, Lei Zheng, Changchun Zhou, Guoxin Li, Rongkang Huang, Huaiming Wang, Chujun Li, Xinjuan Fan, Xinhui Fu, Xinying Wang, Hongliang Guo, Jie Guan, Yanlai Sun, Xilin Song, Zengjun Li, Dianbin Mu, Jujie Sun, Xianglin Liu, Yan Qi, Feng Niu, Chunhua Chen, Xiaolin Wu, Xianshu Wang, Xianrang Song, Hongzhi Zou

Abstract

Background and aims: Stool DNA testing is an emerging and attractive option for colorectal cancer (CRC) screening. We previously evaluated the feasibility of a stool DNA (sDNA) test of methylated SDC2 for CRC detection. The aim of this study was to assess its performance in a multicenter clinical trial setting.

Methods: Each participant was required to undergo a sDNA test and a reference colonoscopy. The sDNA test consists of quantitative assessment of methylation status of SDC2 promoter. Results of real-time quantitative methylation-specific PCR were dichotomized as positive and negative, and the main evaluation indexes were sensitivity, specificity, and kappa value. All sDNA tests were performed and analyzed independently of colonoscopy.

Results: Among the 1110 participants from three clinical sites analyzed, 359 and 38 were diagnosed, respectively, with CRC and advanced adenomas by colonoscopy. The sensitivity of the sDNA test was 301/359 (83.8%) for CRC, 16/38 (42.1%) for advanced adenomas, and 134/154 (87.0%) for early stage CRC (stage I-II). Detection rate did not vary significantly according to age, tumor location, differentiation, and TNM stage, except for gender. The follow-up testing of 40 postoperative patients with CRC returned negative results as their tumors had been surgically removed. The specificity of the sDNA test was 699/713 (98.0%), and unrelated cancers and diseases did not seem to interfere with the testing. The kappa value was 0.84, implying an excellent diagnostic consistency between the sDNA test and colonoscopy.

Conclusion: Noninvasive sDNA test using methylated SDC2 as the exclusive biomarker is a clinically viable and accurate CRC detection method.

Chinese clinical trial registry: Chi-CTR-TRC-1900026409, retrospectively registered on October 8, 2019; http://www.chictr.org.cn/edit.aspx?pid=43888&htm=4 .

Keywords: Advanced adenoma; Colorectal cancer; Methylation; Stool DNA test.

Conflict of interest statement

Xianglin Liu, Yan Qi, Feng Niu, Chunhua Chen, Xiaolin Wu, Xianshu Wang, and Hongzhi Zou are current employees from Creative Biosciences (Guangzhou) CO., Ltd. No potential conflicts of interests were disclosed by the other authors.

Figures

Fig. 1
Fig. 1
The flowchart of study design. * An independent set of 103 patients discussed in the manuscript
Fig. 2
Fig. 2
Amplification by real-time qMSP of ACTB control, methylated, and unmethylated SDC2
Fig. 3
Fig. 3
a Levels of methylated SDC2 in 713 normals, 38 advanced adenomas (AA), and 359 CRCs. b ROC curves of the sDNA testing of SDC2 methylation for the detection of CRC and advanced adenomas

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