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Piper TB, Nielsen HJ, Christensen IJ. Serological cancer-associated protein biomarker levels at bowel endoscopy: Increased risk of subsequent primary malignancy. Tumour Biol 2022; 44:1-16. [PMID: 35180141 DOI: 10.3233/tub-211501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It was previously shown in three subpopulations that subjects not identified with colorectal cancer (CRC) at bowel endoscopy, but with increased serological cancer-associated protein biomarker levels had an increased risk of being diagnosed with subsequent malignant diseases. OBJECTIVE The aim of the present study was to perform a pooled analysis of subjects from the three subpopulations and subsequently validate the results in an independent study. The study population denoted the training set includes N = 4,076 subjects with symptoms attributable to CRC and the independent validation set N = 3,774 similar subjects. METHODS Levels of CEA, CA19-9, TIMP-1 and YKL-40 were determined in blood samples collected prior to diagnostic bowel endoscopy. Follow-up of subjects not diagnosed with CRC at endoscopy, was ten years and identified subjects diagnosed with primary intra- or extra-colonic malignant diseases. The primary analysis was time to a newly diagnosed malignant disease and was analyzed with death as a competing risk in the training set. Subjects with HNPCC or FAP were excluded. The cumulated incidence was estimated for each biomarker and in a multivariate model. The resulting model was then validated on the second study population. RESULTS In the training set primary malignancies were identified in 515 (12.6%) of the 4,076 subjects, who had a colorectal endoscopy with non-malignant findings. In detail, 33 subjects were subsequently diagnosed with CRC and 482 subjects with various extra-colonic cancers. Multivariate additive analysis of the dichotomized biomarkers demonstrated that CEA (HR = 1.50, 95% CI:1.21-1.86, p < 0.001), CA19-9 (HR = 1.41, 95% CI:1.10-1.81, p = 0.007) and TIMP-1 (HR = 1.25 95% CI: 1.01-1.54, p = 0.041) were significant predictors of subsequent malignancy. The cumulated incidence at 5 years landmark time was 17% for those subjects with elevated CEA, CA19-9 and TIMP-1 versus 6.7% for those with low levels of all. When the model was applied to the validation set the cumulated 5-year incidence was 10.5% for subjects with elevated CEA, CA19-9 and TIMP-1 and 5.6% for subjects with low levels of all biomarkers. Further analysis demonstrated a significant interaction between TIMP-1 and age in the training set. The age dependency of TIMP-1 indicated a greater risk of malignancy in younger subjects if the biomarker was elevated. This observation was validated in the second set. CONCLUSION Elevated cancer-associated protein biomarker levels in subjects with non-malignant findings at large bowel endoscopy identifies subjects at increased risk of being diagnosed with subsequent primary malignancy. CEA, CA19-9 and TIMP-1 were significant predictors of malignant disease in this analysis. TIMP-1 was found dependent on age. The results were validated in an independent symptomatic population.
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Affiliation(s)
- Thomas B Piper
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Hans J Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Piper TB, Jørgensen LN, Olsen J, Nielsen KT, Davis G, Johansen JS, Jarle Christensen I, Nielsen HJ. Increased serological, cancer-associated protein biomarker levels at diagnosis of large bowel adenoma: Risk of subsequent primary malignancy? Acta Oncol 2018; 58:S42-S48. [PMID: 30523734 DOI: 10.1080/0284186x.2018.1540885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Blood-based, cancer-associated biomarkers may detect subjects at risk of having neoplastic diseases. The aim of the present study was to evaluate whether elevated serological protein biomarker levels may identify adenoma patients, who are at increased risk of being diagnosed with subsequent primary malignancy. METHODS Levels of CEA, CA19-9, TIMP-1 and YKL-40 were determined in blood samples collected prior to diagnostic bowel endoscopy due to symptoms of colorectal neoplasia. Follow-up time was ten years, and identified adenoma patients, who were diagnosed with subsequent primary intra- or extra-colonic malignant diseases. The biomarker levels were also determined in 400 subjects, who underwent diagnostic colonoscopy, had clean colorectum and were without apparent co-morbidity; these levels were used as reference levels. In the present study, biomarkers were interpreted as elevated when levels were above the reference intervals adjusting for age and gender. The 1-year and 5-years cumulative incidences were calculated. RESULTS Primary malignancies were identified in 175 (19%) of the 923 subjects diagnosed with adenomas at the primary bowel endoscopy. In detail, 20 of the 175 subjects were diagnosed with colorectal cancer (CRC) and 155 subjects with extra-colonic cancers. Thirty patients were diagnosed with malignancy within the first year. Three groups were established: 0: no elevated biomarkers; 1: 1 of the 4 biomarkers elevated; and 2: ≥2 biomarkers elevated. The cumulative 5-years incidence of malignancy was: 0: 6.9%; 1: 11.8%; and 2: 17.5% (p = .0009). CONCLUSION Elevated blood-based, cancer-associated protein biomarker levels in subjects diagnosed with adenomas at large bowel endoscopy identifies subjects at increased risk of being diagnosed with subsequent primary malignancy.
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Affiliation(s)
- Thomas B. Piper
- Department of Surgical Gastroenterology, Center for Surgical Research, Hvidovre Hospital, Hvidovre, Denmark
| | - Lars N. Jørgensen
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Olsen
- Department of Surgical Gastroenterology, Herlev Hospital, Herlev, Denmark
| | | | - Gerard Davis
- Abbott Diagnostics Division R&D, Chicago, IL, USA
| | - Julia S. Johansen
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Oncology, Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Medicine, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Ib Jarle Christensen
- Department of Surgical Gastroenterology, Center for Surgical Research, Hvidovre Hospital, Hvidovre, Denmark
| | - Hans J. Nielsen
- Department of Surgical Gastroenterology, Center for Surgical Research, Hvidovre Hospital, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Wilhelmsen M, Christensen IJ, Jørgensen LN, Madsen MR, Vilandt J, Hillig T, Klærke M, Nielsen KT, Laurberg S, Gawel S, Yang X, Davis G, Heijboer AM, Martens F, Nielsen HJ. Clean Colorectum at Diagnostic Colonoscopy: Subsequent Detection of Extracolonic Malignancies by Plasma Protein Biomarkers? BIOMARKERS IN CANCER 2018; 10:1179299X18776974. [PMID: 29872358 PMCID: PMC5977429 DOI: 10.1177/1179299x18776974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/15/2018] [Indexed: 12/20/2022]
Abstract
Introduction Most of the subjects undergoing diagnostic colonoscopy do not have neoplastic bowel lesions. Potentially, some of the symptoms may therefore be caused by extracolonic malignancy, and subjects with persisting symptoms may need subsequent examinations. Blood-based, cancer-associated biomarkers may aid in directing the examinations for other specific malignant diseases. Methods EDTA plasma samples available from a previous prospective study of subjects undergoing diagnostic colonoscopy were used for analysis of 18 protein biomarkers. The study population of 3732 subjects included 400 patients with colorectal cancer (CRC) and 177 patients with extracolonic malignancies. Univariable analysis of the association of specific biomarkers and extracolonic cancers included those with 10 or more cases. Subsequently, reduced models of 4 or 6 biomarkers, respectively, were established by choosing those with the highest likelihood; age and sex were included as well. Results Univariable analyses showed that CyFra21-1 had an area under curve (AUC) of 0.87 for lung cancers (n = 33), CA19-9 had an AUC of 0.85 for pancreatic cancer (n = 22), CA125 had an AUC of 0.95 for ovary cancer (n = 16), B2M had an AUC of 0.81 for non-Hodgkin lymphoma (n = 12), and total prostate-specific antigen had an AUC of 0.99 for prostate cancer (n = 10). The multivariable analysis of 4 or 6 biomarkers plus age and sex as explanatory variables showed AUCs of 0.82 to 0.85 both for extracolonic cancers and CRC. The 4 biomarkers included in the model for detection of extracolonic cancers were CA125, hsCRP, CA19-9, and CyFra21-1; the 2 additional for the 6 biomarkers model were CEA and Galectin-3. Similarly, the 4 biomarkers included in the model for detection of CRC were CEA, CyFra21-1, Ferritin, and HE4; the two additional for the 6 biomarkers model were hsCRP and Pepsinogen 2. Conclusions Results of this study indicate that it may be possible to detect subjects that have an increased risk of extracolonic cancer following a colonoscopy without findings of neoplastic lesions. Combinations of various protein biomarkers may direct subsequent examination after colonoscopy with clean colorectum. The results, although preliminary, may form the basis for additional research directed both for primary examinations of subjects with symptoms of malignancy and subsequent examinations after colonoscopy.
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Affiliation(s)
- Michael Wilhelmsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Ib J Christensen
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Lars N Jørgensen
- Department of Surgical Gastroenterology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Jesper Vilandt
- Department of Surgery, Hillerød Hospital, Hillerød, Denmark
| | - Thore Hillig
- Department of Clinical Biochemistry, Hillerød Hospital, Hillerød, Denmark
| | - Michael Klærke
- Department of Surgery, Horsens Hospital, Horsens, Denmark
| | - Knud T Nielsen
- Department of Surgery, Randers Hospital, Randers, Denmark
| | - Søren Laurberg
- Department of Surgical Gastroenterology, Aarhus Hospital THG, Aarhus, Denmark
| | - Susan Gawel
- Abbott Cancer Core R&D, Abbott Diagnostics Division, Abbott Park, Chicago, IL, USA
| | - Xiaoping Yang
- Abbott Cancer Core R&D, Abbott Diagnostics Division, Abbott Park, Chicago, IL, USA
| | - Gerard Davis
- Abbott Cancer Core R&D, Abbott Diagnostics Division, Abbott Park, Chicago, IL, USA
| | | | - Frans Martens
- Department of Clinical Chemistry, VUMC, Amsterdam, The Netherlands
| | - Hans J Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
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Wilhelmsen M, Christensen IJ, Rasmussen L, Jørgensen LN, Madsen MR, Vilandt J, Hillig T, Klaerke M, Nielsen KT, Laurberg S, Brünner N, Gawel S, Yang X, Davis G, Heijboer A, Martens F, Nielsen HJ. Detection of colorectal neoplasia: Combination of eight blood-based, cancer-associated protein biomarkers. Int J Cancer 2017; 140:1436-1446. [PMID: 27935033 DOI: 10.1002/ijc.30558] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/08/2016] [Indexed: 12/11/2022]
Abstract
Serological biomarkers may be an option for early detection of colorectal cancer (CRC). The present study assessed eight cancer-associated protein biomarkers in plasma from subjects undergoing first time ever colonoscopy due to symptoms attributable to colorectal neoplasia. Plasma AFP, CA19-9, CEA, hs-CRP, CyFra21-1, Ferritin, Galectin-3 and TIMP-1 were determined in EDTA-plasma using the Abbott ARCHITECT® automated immunoassay platform. Primary endpoints were detection of (i) CRC and high-risk adenoma and (ii) CRC. Logistic regression was performed. Final reduced models were constructed selecting the four biomarkers with the highest likelihood scores. Subjects (N = 4,698) were consecutively included during 2010-2012. Colonoscopy detected 512 CRC patients, 319 colonic cancer and 193 rectal cancer. Extra colonic malignancies were detected in 177 patients, 689 had adenomas of which 399 were high-risk, 1,342 had nonneoplastic bowell disease and 1,978 subjects had 'clean' colorectum. Univariable analysis demonstrated that all biomarkers were statistically significant. Multivariate logistic regression demonstrated that the blood-based biomarkers in combination significantly predicted the endpoints. The reduced model resulted in the selection of CEA, hs-CRP, CyFra21-1 and Ferritin for the two endpoints; AUCs were 0.76 and 0.84, respectively. The postive predictive value at 90% sensitivity was 25% for endpoint 1 and the negative predictive value was 93%. For endpoint 2, the postive predictive value was 18% and the negative predictive value was 97%. Combinations of serological protein biomarkers provided a significant identification of subjects with high risk of the presence of colorectal neoplasia. The present set of biomarkers could become important adjunct in early detection of CRC.
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Affiliation(s)
- Michael Wilhelmsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Ib J Christensen
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Louise Rasmussen
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Lars N Jørgensen
- Department of Surgical Gastroenterology, Bispebjerg Hospital, University of Copenhagen, København, Denmark
| | - Mogens R Madsen
- Department of Surgical Gastroenterology, Herning Hospital, University of Copenhagen, Herning, Denmark
| | - Jesper Vilandt
- Department of Surgical Gastroenterology, Hillerød Hospital, University of Copenhagen, Hillerød, Denmark
| | - Thore Hillig
- Department of Clinical Biochemistry, Hillerød Hospital, Denmark
| | - Michael Klaerke
- Department of Surgical Gastroenterology, Horsens Hospital, University of Copenhagen, Horsens, Denmark
| | - Knud T Nielsen
- Department of Surgical Gastroenterology, Randers Hospital, University of Copenhagen, Randers, Denmark
| | - Søren Laurberg
- Department of Surgical Gastroenterology, Aarhus Hospital, University of Copenhagen, Aarhus, Denmark
| | - Nils Brünner
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Susan Gawel
- Cancer Core R&D, Abbott Diagnostics Division, Abbott Park, Chicago, IL, USA
| | - Xiaoqing Yang
- Cancer Core R&D, Abbott Diagnostics Division, Abbott Park, Chicago, IL, USA
| | - Gerard Davis
- Cancer Core R&D, Abbott Diagnostics Division, Abbott Park, Chicago, IL, USA
| | - Annemieke Heijboer
- Department of Clinical Biochemistry, VU medical center, Amsterdam, The Netherlands
| | - Frans Martens
- Department of Clinical Biochemistry, VU medical center, Amsterdam, The Netherlands
| | - Hans J Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
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Nielsen HJ. Increased serological cancer-associated biomarkers and risk of development of primary malignancy after large bowel endoscopy. Scand J Gastroenterol 2016; 51:1272. [PMID: 27310310 DOI: 10.1080/00365521.2016.1195442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Hans Jørgen Nielsen
- a Department of Surgical Gastroenterology , Hvidovre Hospital , Hvidovre , Denmark
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Rasmussen L, Wilhelmsen M, Christensen IJ, Andersen J, Jørgensen LN, Rasmussen M, Hendel JW, Madsen MR, Vilandt J, Hillig T, Klærke M, Münster AMB, Andersen LM, Andersen B, Hornung N, Erlandsen EJ, Khalid A, Nielsen HJ. Protocol Outlines for Parts 1 and 2 of the Prospective Endoscopy III Study for the Early Detection of Colorectal Cancer: Validation of a Concept Based on Blood Biomarkers. JMIR Res Protoc 2016; 5:e182. [PMID: 27624815 PMCID: PMC5039335 DOI: 10.2196/resprot.6346] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/12/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Programs for population screening of colorectal cancer (CRC) have been implemented in several countries with fecal immunochemical testing (FIT) as the preferred platform. However, the major obstacle for a feces-based testing method is the limited compliance that reduces the clinical sensitivity for detection of participants with non-symptomatic CRC. Therefore, research approaches have been initiated to develop screening concepts based on biomarkers in blood. Preliminary results show that protein, genetic, epigenetic, and metabolomic components may be valuable in blood-based screening concepts, particularly when combinations of the various components appear to lead to significant improvements. OBJECTIVES The protocol described in this paper focuses on the validation of concepts based on biomarkers in blood in a major population screened by FIT. METHODS In Part 1, participants will be identified and included through the Danish CRC Screening Program comprising initial FIT and subsequent colonoscopy to those with a positive result. Blood samples will be collected from 8000 FIT-positive participants, who are offered subsequent colonoscopy. Findings and interventions at colonoscopy together with personal data including co-morbidity will be recorded. Blood samples and data will also be collected from 6000 arbitrarily chosen participants with negative FIT. In Part 2, blood samples and data will be collected from 30,000 FIT-negative participants three times within 4 years. The blood samples will be analyzed using various in-house and commercially available manual and automated analysis platforms. RESULTS We anticipate Part 1 to terminate late August 2016 and Part 2 to terminate late September 2022. The results from Parts 1 and 2 will be presented within 12 to 18 months from termination. CONCLUSIONS The purpose of this study is to improve the efficacy of identifying participants with neoplastic bowel lesions, to identify false negative participants, to identify participants at risk of interval neoplastic lesions, to improve the compliance in screening sessions, and to establish guidelines for out-patient follow-up of at-risk participants based on combinations of blood-based biomarkers.
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Affiliation(s)
- Louise Rasmussen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark.
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Hvolris MH, Piper TB, Hammer E, Jørgensen LN, Olsen J, Rahr HB, Nielsen KT, Laurberg S, Christensen IJ, Brünner N, Johansen JS, Davis GJ, Dowell BL, Nielsen HJ. Increased serological cancer-associated biomarker levels at large bowel endoscopy and risk of subsequent primary cancer (†). Scand J Gastroenterol 2016; 51:860-5. [PMID: 26918701 DOI: 10.3109/00365521.2016.1144783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Frequently, subjects offered colonoscopy due to symptoms of colorectal neoplasia are diagnosed with diverticula. The symptoms may, however, also be related to extra-colonic neoplasia. The present retrospective study evaluated a possible association between increased levels of predefined biomarkers in subjects diagnosed with diverticula and risk of developing a primary malignant disease. METHODS During 2004/2005, about 4509 subjects were included in a multicenter study with collection of blood samples before bowel endoscopy. The aim was to evaluate a relation between the protein biomarkers CEA, TIMP-1, CA19-9 and YKL-40 and findings at endoscopy. Diverticula were diagnosed in 1021 subjects. By 31 December 2012, subjects who had developed primary malignancy were identified retrospectively and relation between biomarker levels at endoscopy and risk of developing primary malignancy was calculated. The relation with the four biomarkers was divided into three groups: 0 = none increased; 1 = one increased and 2 = two or more increased. RESULTS In the observation period, 148 subjects developed a primary malignant disease. Univariable analyzes of the biomarker levels showed that CEA, TIMP-1 and CA19-9 were significantly associated with development of primary malignancy. A multivariable analysis showed that increased levels were associated with development of malignancy (p < 0.0001). The 1- and 5-year cumulative risks of being diagnosed with a primary malignancy were: group 0: 1.1%/5.5%; group 1: 4.2%/10.1% and group 2: 11.4%/18.8%, respectively. CONCLUSION Increased levels of CEA, TIMP-1 and CA19-9 at endoscopy with findings of diverticula were associated with a significantly increased risk of being diagnosed with a subsequent primary malignant disease.
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Affiliation(s)
- Martin H Hvolris
- a Department of Surgical Gastroenterology , Hvidovre Hospital , Hvidovre , Denmark
| | - Thomas B Piper
- a Department of Surgical Gastroenterology , Hvidovre Hospital , Hvidovre , Denmark
| | - Emilie Hammer
- a Department of Surgical Gastroenterology , Hvidovre Hospital , Hvidovre , Denmark
| | - Lars N Jørgensen
- b Department of Surgical Gastroenterology , Bispebjerg Hospital , Bispebjerg , Denmark
| | - Jesper Olsen
- c Department of Surgical Gastroenterology , Glostrup Hospital , Glostrup , Denmark
| | - Hans B Rahr
- d Department of Surgical Gastroenterology , Odense University Hospital , Odense , Denmark
| | - Knud T Nielsen
- e Department of Surgery , Randers Hospital , Randers , Denmark
| | - Søren Laurberg
- f Department of Surgical Gastroenterology , Aarhus University Hospital , Aarhus , Denmark
| | - Ib J Christensen
- a Department of Surgical Gastroenterology , Hvidovre Hospital , Hvidovre , Denmark
| | - Nils Brünner
- g Institute of Veterinary Disease Biology, University of Copenhagen , Frederiksberg , Denmark
| | | | - Gerard J Davis
- i Abbott Laboratories Inc, Cancer Core R&D , Abbott Park , IL , USA
| | - Barry L Dowell
- i Abbott Laboratories Inc, Cancer Core R&D , Abbott Park , IL , USA
| | - Hans J Nielsen
- a Department of Surgical Gastroenterology , Hvidovre Hospital , Hvidovre , Denmark ;,j Institute of Clinical Medicine, University of Copenhagen , Copenhagen , Denmark
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