FECAL CALPROTECTIN AS A DIAGNOSTIC MARKER OF COLORECTAL CANCER IN PERSONS WITH DIVERTICULAR DISEASE OF THE COLON
Abstract
Introduction. Diverticular disease of the colon (DD) and colorectal cancer (CRC) are the two most common gastrointestinal diseases that place a high burden on the healthcare system. Screening for CRC in DBTC is associated with significant material costs for colonoscopy followed by biopsy from the intestinal mucosa. To determine the prognostic significance of fecal calprotectin (FC) in patients with (DD) and in its combination with CRC. The aim is to determine the prognostic significance of fecal calprotectin (FC) in patients with diverticular disease of the colon (DD) and in its combination with colorectal cancer (CRC). Materials and methods. The study included 60 patients over 40 years of age with DD, who were divided into 2 groups: the first group included 30 patients with DD; the second group included 30 patients with DD and CRC (stages I or II). The comparison group consisted of 25 practically healthy people who underwent a routine medical examination. All patients were examined in accordance with the purpose and objectives of this work according to a single program, including routine laboratory and instrumental (colonoscopy and ultrasound examination of the abdominal organs) data. All patients underwent stool testing for occult blood and FC levels. Results. In patients with DD, a positive fecal occult blood reaction was found in 3.3%, and when combined with CRC, in 30% (p <0.05). In patients with DD, FC values were most often determined in the range from 50 to 200 μg/g (which may indicate an organic disease in remission) — in 33.3%, and in patients with DD in combination with CRC — in 60% (p <0.05). In patients with DD, the level of FC was significantly higher than in representatives of the group of practically healthy patients (p <0.05). Thus, in the group with DD in combination with CRC, the FA level was 83.53 μg/g, in the group with DD 67.24 μg/g, while the values of this indicator in the group of practically healthy patients were 31.12 μg/g (p <0.05). A comparison between patients with DD and CRC showed that patients with DD in combination with CRC had higher FC values (p <0.05). Conclusions. FC is a prognostically valuable marker for the detection of CRC in patients with DD.
References
Shahedi K., Fuller G., Bolus R. et al. Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy. Clin Gastroenterol Hepatol. 2013; 11(12): 1609–13. DOI: 10.1016/j.cgh.2013.06.020.
Sung H., Ferlay J., Siegel R.L. et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3): 209–49. DOI: 10.3322/caac.21660.
Осадчук М.А., Свистунов А.А., Золотовицкая А.М. и др. Дивертикулярная болезнь толстой кишки и ее ассоциация с полипами и колоректальным раком: клинико-инструментальное и иммуноморфологическое исследование. Медицинский вестник Северного Кавказа. 2020; 15(1): 52–7. DOI: 10.14300/mnnc.2020.15011.
Осадчук М.А., Свистунов А.А., Золотовицкая А.М. и др. Прогнозирование течения дивертикулярной болезни толстого кишечника при ее сочетании с аденоматозными полипами и раком кишечника в контексте клинико-инструментальных данных и экспрессии Ki-67 и α-SMA в слизистой оболочке кишечника. Медицинский вестник Северного Кавказа. 2019; 14(4): 609–14. DOI: 10.14300/mnnc.2019.14152.
Meyer J., Buchs N.C., Ris F. Risk of colorectal cancer in patients with diverticular disease. World J Clin Oncol. 2018; 9(6): 119–22. DOI: 10.5306/wjco.v9.i6.119.
Ma W., Walker M.M., Thuresson M. et al. Cancer risk in patients with diverticular disease: A nationwide cohort study. JNCI Journal of the National Cancer Institute. 2023; 115(1): 62. DOI: 10.1093/jnci/djac190.
Yamamoto T., Kawada K., Obama K. Inflammation-Related Biomarkers for the Prediction of Prognosis in Colorectal Cancer Patients. Int J Mol Sci. 2021; 22(15): 8002. DOI: 10.3390/ijms22158002.
Tursi A., Elisei W. Role of Inflammation in the Pathogenesis of Diverticular Disease. Mediators Inflamm. 2019; 2019: 8328490. DOI: 10.1155/2019/8328490.
Tibble J.A., Sigthorsson G., Foster R. et al. Use of surrogate markers of inflammation and Rome criteria to distinguish organic from nonorganic intestinal disease. Gastroenterology. 2002; 123(2): 450–60. DOI: 10.1053/gast.2002.34755.
Российская гастроэнтерологическая ассоциация, Ассоциация колопроктологов России. Клинические рекомендации. Дивертикулярная болезнь. 2021: 48.
Ассоциация онкологов России, Общероссийская общественная организация «Российское общество клинической онкологии», Российское общество специалистов по колоректальному раку, Общероссийская общественная организация «Ассоциация колопроктологов России». Клинические рекомендации. Злокачественное новообразование ободочной кишки. 2022.
Tursi A. Biomarkers in diverticular diseases of the colon. Dig Dis. 2012; 30(1): 12–8. DOI: 10.1159/000335695.
Widlak M.M., Thomas C.L., Thomas M.G. et al. Diagnostic accuracy of faecal biomarkers in detecting colorectal cancer and adenoma in symptomatic patients. Aliment Pharmacol Ther. 2017; 45(2): 354–63. DOI: 10.1111/apt.13865.
Tursi A., Brandimarte G., Elisei W. et al. Faecal calprotectin in colonic diverticular disease: a case-control study. Int J Colorectal Dis. 2009; 24(1): 49–55. DOI: 10.1007/s00384-008-0595-9.
Mowat C., Digby J., Strachan J.A. et al. Faecal haemoglobin and faecal calprotectin as indicators of bowel disease in patients presenting to primary care with bowel symptoms. Gut. 2016; 65(9): 1463–9. DOI: 10.1136/gutjnl-2015-309579.
Tursi A., Elisei W., Picchio M. et al. Moderate to severe and prolonged left lower-abdominal pain is the best symptom characterizing symptomatic uncomplicated diverticular disease of the colon: a comparison with fecal calprotectin in clinical setting. J Clin Gastroenterol. 2015; 49(3): 218–21. DOI: 10.1097/MCG.0000000000000094.
Blad N., Palmqvist R., Karling P. Pre-diagnostic faecal calprotectin levels in patients with colorectal cancer: a retrospective study. BMC Cancer. 2022;22:315. DOI: 10.1186/s12885-022-09440-4.
Wisse PHA., de Klaver W., van Wifferen F. et al. The multitarget fecal immunochemical test versus the fecal immunochemical test for programmatic colorectal cancer screening: a cross-sectional intervention study with paired design. BMC Cancer. 2022; 22: 1299. DOI: 10.1186/s12885-022-10372-2.
Ross F.A., Park J.H., Mansouri D. et al. The role of faecal calprotectin in diagnosis and staging of colorectal neoplasia: a systematic review and meta-analysis. BMC Gastroenterol. 2022; 22: 176. DOI: 10.1186/s12876-022-02220-1.
Lu M., Wang L., Zhang Y. et al. Optimizing Positivity Thresholds for a Risk-Adapted Screening Strategy in Colorectal Cancer Screening. Clin Transl Gastroenterol. 2021; 12(8): e00398. DOI: 10.14309/ctg.0000000000000398.
Røseth A.G., Kristinsson J., Fagerhol M.K. et al. Faecal calprotectin: a novel test for the diagnosis of colorectal cancer? Scand J Gastroenterol. 1993; 28(12): 1073–6. DOI: 10.3109/00365529309098312.
Lehmann F.S., Trapani F., Fueglistaler I. et al. Clinical and histopathological correlations of fecal calprotectin release in colorectal carcinoma. World J Gastroenterol. 2014; 20(17): 4994–9. DOI: 10.3748/wjg.v20.i17.4994.
Tibble J., Sigthorsson G., Foster R. et al. Faecal calprotectin and faecal occult blood tests in the diagnosis of colorectal carcinoma and adenoma. Gut. 2001; 49(3): 402–8. DOI: 10.1136/gut.49.3.402.
