Using serum placenta growth factor could improve the sensitivity of colorectal cancer screening in fecal occult blood negative population: A multicenter with independent cohort validation study

Shu-Chen Wei; Po-Nien Tsao; Yu-Ting Wang; Been-Ren Lin; Deng-Chyang Wu; Wen-Sy Tsai; Jinn-Shiun Chen; Jau-Min Wong

doi:10.1002/cam4.2216

Using serum placenta growth factor could improve the sensitivity of colorectal cancer screening in fecal occult blood negative population: A multicenter with independent cohort validation study

Cancer Med. 2019 Jul;8(7):3583-3591. doi: 10.1002/cam4.2216. Epub 2019 May 7.

Authors

Shu-Chen Wei¹, Po-Nien Tsao^{2

3}, Yu-Ting Wang⁴, Been-Ren Lin⁵, Deng-Chyang Wu⁶, Wen-Sy Tsai^{7

8}, Jinn-Shiun Chen⁷, Jau-Min Wong¹

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
² Department of Pediatrics, National Taiwan University Children's Hospital and National Taiwan University, Taipei, Taiwan.
³ The Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan.
⁴ Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
⁵ Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
⁶ Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁷ Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
⁸ School of Medicine, Chang Gung University, Taoyuan, Taiwan.

Abstract

Background: Colorectal cancer (CRC) is one of the most common cancers worldwide. Screening for CRC using the fecal occult blood test (FOBT) is feasible and useful for decreasing disease-related mortality; however, its sensitivity and compliance are unsatisfactory.

Methods: This study examined the efficacy of using serum placenta growth factor (PlGF) for a novel CRC screening strategy. To investigate a potential novel screening tool for CRC, we compared the sensitivity, specificity, positive predictive value, and negative predictive value of the FOBT, serum PlGF, and their combination through an examination of two independent cohorts and validation using the second cohort. All the patients and control group received the colonoscopy and FOBT, the colonoscopy was used as the gold standard for the result.

Results: Serum PlGF levels were significantly increased in CRC patients (16.8 ± 11.4 pg/mL) compared with controls (12.0 ± 11.2 pg/mL). The predictive model that used the serum PlGF level alone was as effective as the FOBT (AUC: 0.60 vs 0.68, P = 0.891), and it had significantly higher sensitivity than the FOBT (0.81 vs 0.39). In addition, we found serum PlGF level has a good value for predicting CRC patients in those FOBT negative populations. Finally, combining serum PlGF level and the FOBT improved the predictive power and demonstrated satisfactory sensitivity (0.71) and specificity (0.71). This result was confirmed and validated in the second independent cohort. Furthermore, no matter the stages (early/advanced) and the location (distal/proximal) of CRC, the efficacy of serum PlGF and the combined model remained quite stable.

Conclusion: Serum PlGF level is a potential alternative screening tool for CRC, especially for those who are reluctant to stool-based screening methods and who were tested as negative FOBT. In addition, combining serum PlGF level and the FOBT could increase the power of CRC screening.

Keywords: FOBT; colorectal cancer; serum PlGF.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Area Under Curve
Biomarkers
Colorectal Neoplasms / blood*
Colorectal Neoplasms / diagnosis*
Colorectal Neoplasms / epidemiology
Early Detection of Cancer / methods
Female
Humans
Male
Mass Screening
Middle Aged
Neoplasm Staging
Placenta Growth Factor / blood*
Prognosis
Reproducibility of Results
Sensitivity and Specificity

Substances

Biomarkers
PGF protein, human
Placenta Growth Factor