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Meta-Analysis
. 2022 Feb 16;12(1):2623.
doi: 10.1038/s41598-022-06689-4.

Comparison of faecal protein biomarkers' diagnostic accuracy for colorectal advanced neoplasms: a systematic review and meta-analysis

Atefeh Nasir Kansestani #  1 , Mohammad Erfan Zare #  1 , Qingchao Tong  1 , Jun Zhang  2
Affiliations
Meta-Analysis

Comparison of faecal protein biomarkers' diagnostic accuracy for colorectal advanced neoplasms: a systematic review and meta-analysis

Atefeh Nasir Kansestani et al. Sci Rep. .

Abstract

Early diagnosis of colorectal advanced neoplasms (ANs), including colorectal cancer (CRC) and advanced adenoma (AA), has a positive effect on the survival rate. As a first attempt, the aim of this meta-analysis was to compare the diagnostic accuracy of faecal protein biomarkers for the detection of colorectal neoplasms with consideration of a wide range of covariates. A systematic literature search was performed up to Jun 10, 2021 on Web of Sciences, Scopus and PubMed. The diagnostic accuracies were calculated using the bivariate/hierarchical random effect model. Biomarkers were determined to be clinically applicable (CA) if they had areas under the curve > 0.70 and positive and negative likelihood ratios > 2 and < 0.5, respectively. A total of 47,059 test results were extracted from 16 immunochemical faecal occult blood test (iFOBT), 26 pyruvate kinase-M2 (PK-M2) and 23 faecal calprotectin (FC) studies. Only iFOBT, PK-M2 and FC for CRC plus iFOBT and PK-M2 for AN were CA. iFOBT had significantly superior accuracy (P = 0.02 versus PK-M2 and P < 0.01 versus FC for CRC; P < 0.01 versus PK-M2 for AN). Regarding covariates, the lateral flow method of PK-M2 measurement increased its accuracy for CRC detection compared to the enzyme-linked immunosorbent assay (P < 0.01). iFOBT is recommended as the most accurate faecal biomarker for CRC and AN diagnosis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flowchart diagram of study selection and quality assessment of included studies utilizing the QUADAS-2. (A) Flowchart diagram of study selection based on the inclusion and exclusion criteria; (B) QUADAS-2 diagram for iFOBT; (C) QUADAS-2 diagram for PK-M2; (D) QUADAS-2 diagram for FC. iFOB immunochemical faecal occult blood tests, PK-M2 pyruvate kinase-M2, FC faecal calprotectin, QUADAS-2 quality assessment of diagnostic accuracy studies-2.
Figure 2
Figure 2
Forest plot, HSROC and LR scattergram of clinically applicable faecal protein biomarkers for CRC diagnosis. (A) Forest plot of iFOBT; (B) forest plot PK-M2; (C) forest plot of FC; (D) comparison of HSROCs of clinically applicable faecal protein biomarkers; (E) LR scattergram of clinically applicable faecal protein biomarkers. CRC colorectal cancer, iFOBT immunochemical faecal occult blood tests, PK-M2 pyruvate kinase-M2, FC faecal calprotectin, LUQ left upper quadrant, RUQ right upper quadrant, LLQ left lower quadrant, RLQ right lower quadrant.
Figure 2
Figure 2
Forest plot, HSROC and LR scattergram of clinically applicable faecal protein biomarkers for CRC diagnosis. (A) Forest plot of iFOBT; (B) forest plot PK-M2; (C) forest plot of FC; (D) comparison of HSROCs of clinically applicable faecal protein biomarkers; (E) LR scattergram of clinically applicable faecal protein biomarkers. CRC colorectal cancer, iFOBT immunochemical faecal occult blood tests, PK-M2 pyruvate kinase-M2, FC faecal calprotectin, LUQ left upper quadrant, RUQ right upper quadrant, LLQ left lower quadrant, RLQ right lower quadrant.
Figure 3
Figure 3
Forest plot, HSROC and LR scattergram of clinically applicable faecal protein biomarkers for AN diagnosis. (A) Forest plot of iFOBT; (B) Forest plot PK-M2; (C) comparison of the HSROCs of clinically applicable faecal protein biomarkers; (D) LR scattergram of clinically applicable faecal protein biomarkers. AN advanced neoplasms, iFOBT immunochemical faecal occult blood tests, PK-M2 pyruvate kinase-M2, LUQ left upper quadrant, RUQ right upper quadrant, LLQ left lower quadrant, RLQ right lower quadrant.
Figure 4
Figure 4
Comparison of the HSROCs of PK-M2 with different methods of measurement. iFOBT immunochemical faecal occult blood tests, PK-M2 pyruvate kinase-M2, ELISA enzyme-linked immunosorbent assay.
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