title: Comparison and combination of blood-based inflammatory markers with faecal occult blood tests for non-invasive colorectal cancer screening.
abstract: BACKGROUND
  Faecal occult blood tests (FOBTs) are widely used for colorectal cancer (CRC) screening. Blood-based inflammatory markers have been suggested as alternative or supplementary non-invasive CRC screening tests.
  
  
  METHODS
  Among 179 CRC patients, 193 people with advanced adenoma and 225 people free of neoplasm, C-reactive protein (CRP), serum CD26 (sCD26), complement C3a anaphylatoxin and tissue inhibitor of metalloproteinases 1 (TIMP-1) levels in blood were measured by ELISA tests, and an immunochemical FOBT (iFOBT) and a guaiac-based FOBT were performed. Receiver operating characteristic curves were constructed and the areas under the curves (AUCs) were compared.
  
  
  RESULTS
  The blood levels of CRP, sCD26 and TIMP-1 showed statistically significant differences between CRC patients and neoplasm-free participants, and levels of TIMP-1 were furthermore significantly elevated in advanced adenoma patients. For the four inflammatory markers, AUCs ranged from 0.52 to 0.62 for CRC detection and from 0.50 to 0.58 for advanced adenomas detection, compared with AUCs of 0.90 and 0.68 for the iFOBT. At 97% specificity, blood markers showed much lower sensitivities than FOBTs. Combining inflammatory markers with the iFOBT increased the AUC for advanced adenomas.
  
  
  CONCLUSIONS
  These blood-based markers do not seem to be an alternative to FOBT-based CRC screening. The potential use of these and other blood-based tests in combination with iFOBT might deserve further attention.
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre, Heidelberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Tao
authors.forename: U
authors.initials: U
authors.lastname: Haug
authors.forename: K
authors.initials: K
authors.lastname: Kuhn
authors.forename: H
authors.initials: H
authors.lastname: Brenner
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D015179:Colorectal Neoplasms / Q000097:blood / Q000175:diagnosis*; D018819:Dipeptidyl Peptidase 4 / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007120:Immunochemistry; D007249:Inflammation / Q000097:blood*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009780:Occult Blood; D012680:Sensitivity and Specificity; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000097:blood
chemical_list: D014408:Biomarkers, Tumor; C560822:TIMP1 protein, human; D019715:Tissue Inhibitor of Metalloproteinase-1; D002097:C-Reactive Protein; D018819:Dipeptidyl Peptidase 4