Early detection and follow‐up of colorectal neoplasia based on faecal volatile organic compounds
基于糞便揮發性有機物的結直腸腫瘤早期檢測及隨訪
Sofie Bosch Rianne Bot Alfian Wicaksono Edo Savelkoul René van der Hulst Johan Kuijvenhoven
Pieter Stokkers Emma Daulton James A Covington Tim GJ de Meij Nanne KH de Boer
Abstract
Aim
Early detection and removal of colorectal cancer (CRC) and advanced adenomas (AA) decreases the incidence and mortality from the disease. We aimed to evaluate the potential of faecal volatile organic compounds (VOC) for colorectal adenoma detection and follow‐up using advanced electronic nose technology.
早期發現和切除結直腸癌(CRC)和晚期腺瘤(AA)可降低該病的發病率和死亡率。我們旨在評估糞便揮發性有機化合物(VOC)在大腸腺瘤檢測和隨訪中的應用潛力。
Method
This was a prospective multi‐centre case‐control cohort including two district hospitals and one tertiary referral hospital. Patients undergoing colonoscopy were instructed to collect a faecal sample prior to bowel cleansing and were included when CRC, AA, large adenomas (LA; 0.5‐1.0cm), small adenomas (SA; 0.1‐0.5cm) or no endoscopic abnormalities (controls; C) were observed. Patients undergoing polypectomy and C were asked for a second sample after three months. Faecal VOCs were measured with gas chromatography‐ion mobility spectrometry. Random Forest, Support Vector Machine, Gaussian Process and Neural Net classification were used to evaluate accuracy.
這是一個前瞻性多中心病例對照隊列，包括兩個地區醫院和一個三級轉診醫院。接受*檢查的患者在腸道清潔前收集糞便樣本，并包括在觀察到CRC、AA、大腺瘤(LA；0.5‐1.0cm)、小腺瘤(SA；0.1‐0.5cm)或無內鏡異常(對照組；C)時。三個月后，接受息肉切除術和C組的患者被要求進行第二次取樣。采用氣相色譜-離子遷移光譜法測定糞便中的揮發性有機物。采用隨機森林、支持向量機、高斯過程和神經網絡分類等方法進行精度評價。
Results
In total, 14 CRC, 64 AA, 69 LA, 127 SA and 227 C were included. A second sample was collected by 32 polypectomy patients and 32 C. Faecal VOCs discriminated CRC and adenomas from C (AUC(95%): CRC vs C 0.96(0.89‐1); AA vs C 0.96(0.93‐1); LA vs C 0.96(0.92‐0.99); SA vs C 0.96(0.94‐0.99)). There were no significant differences between CRC and adenoma groups. Patients with adenomas and C were discriminated prior to polypectomy, whereas three months after polypectomy VOC profiles were similar (T0 adenoma vs C 0.98(0.95‐1); T1 adenoma vs C 0.55(0.40‐0.69)).
總共包括14個CRC、64個AA、69個LA、127個SA和227個C。第二個樣本由32名息肉切除患者和32名C.糞便揮發性有機化合物(VOCs)收集，它們區分了C(AUC)(95%)：CRC與C 0.96(0.89‐1)；AA與C 0.96(0.93‐1)；LA與C 0.96(0.92‐0.99)；SA與C 0.96(0.94‐0.99)。結直腸癌組與腺瘤組之間無顯著性差異。腺瘤患者和C患者在息肉切除術前進行鑒別，而息肉切除術后3個月VOC曲線相似(T0腺瘤vs C 0.98(0.95‐1)；T1腺瘤vs c0.55(0.40‐0.69))
Conclusions
Faecal VOC profiles may be useful for early CRC and adenoma detection, and timing of polyp surveillance as polypectomy led to a normalization of the VOC profile.
糞便中揮發性有機化合物的分布可能有助于早期發現結直腸癌和腺瘤，息肉切除后監測息肉的時間可使揮發性有機化合物分布正常化。
