Diagnostic value of stool DNA testing for multiple markers of colorectal cancer and advanced adenoma: a meta-analysis.
OBJECTIVE
The diagnostic value of stool DNA (sDNA) testing for colorectal neoplasms remains controversial. To compensate for the lack of large-scale unbiased population studies, a meta-analysis was performed to evaluate the diagnostic value of sDNA testing for multiple markers of colorectal cancer (CRC) and advanced adenoma.


METHODS
The PubMed, Science Direct, Biosis Review, Cochrane Library and Embase databases were systematically searched in January 2012 without time restriction. Meta-analysis was performed using a random-effects model using sensitivity, specificity, diagnostic OR (DOR), summary ROC curves, area under the curve (AUC), and 95% CIs as effect measures. Heterogeneity was measured using the χ(2) test and Q statistic; subgroup analysis was also conducted.


RESULTS
A total of 20 studies comprising 5876 individuals were eligible. There was no heterogeneity for CRC, but adenoma and advanced adenoma harboured considerable heterogeneity influenced by risk classification and various detection markers. Stratification analysis according to risk classification showed that multiple markers had a high DOR for the high-risk subgroups of both CRC (sensitivity 0.759 [95% CI 0.711 to 0.804]; specificity 0.883 [95% CI 0.846 to 0.913]; AUC 0.906) and advanced adenoma (sensitivity 0.683 [95% CI 0.584 to 0.771]; specificity 0.918 [95% CI 0.866 to 0.954]; AUC 0.946) but not for the average-risk subgroups of either. In the methylation subgroup, sDNA testing had significantly higher DOR for CRC (sensitivity 0.753 [95% CI 0.685 to 0.812]; specificity 0.913 [95% CI 0.860 to 0.950]; AUC 0.918) and advanced adenoma (sensitivity 0.623 [95% CI 0.527 to 0.712]; specificity 0.926 [95% CI 0.882 to 0.958]; AUC 0.910) compared with the mutation subgroup. There was no significant heterogeneity among studies for subgroup analysis.


CONCLUSIONS
sDNA testing for multiple markers had strong diagnostic significance for CRC and advanced adenoma in high-risk subjects. Methylation makers had more diagnostic value than mutation markers.
Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Hua
H
Yang
Bing-Qing
BQ
Xia
Bo
B
Jiang
Guozhen
G
Wang
Yi-Peng
YP
Yang
Hao
H
Chen
Bing-Sheng
BS
Li
An-Gao
AG
Xu
Yun-Bo
YB
Huang
Xin-Ying
XY
Wang
D000236:Adenoma / Q000175:diagnosis*; D019540:Area Under Curve; D014408:Biomarkers, Tumor / Q000032:analysis*; D003110:Colonic Neoplasms / Q000175:diagnosis*; D004247:DNA / Q000032:analysis*; D019175:DNA Methylation / Q000235:genetics; D005243:Feces / Q000737:chemistry*; D006801:Humans; D009154:Mutation / Q000235:genetics; D012372:ROC Curve; D012004:Rectal Neoplasms / Q000175:diagnosis*; D018570:Risk Assessment; D012680:Sensitivity and Specificity
D014408:Biomarkers, Tumor; D004247:DNA