early detection and follow‐up of colorectal neoplasia based on faecal volatile organic compounds
基于粪便挥发性有机物的结直肠肿瘤早期检测及随访
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
aimearly 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.
早期发现和切除结直肠癌（crc）和晚期腺瘤（aa）可降低该病的发病率和死亡率。我们旨在评估粪便挥发性有机化合物（voc）在大肠腺瘤检测和随访中的应用潜力。
methodthis 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.
这是一个前瞻性多中心病例对照队列，包括两个地区医院和一个三级转诊医院。接受检查的患者在肠道清洁前收集粪便样本，并包括在观察到crc、aa、大腺瘤（la；0.5‐1.0cm）、小腺瘤（sa；0.1‐0.5cm）或无内镜异常（对照组；c）时。三个月后，接受息肉切除术和c组的患者被要求进行第二次取样。采用气相色谱-离子迁移光谱法测定粪便中的挥发性有机物。采用随机森林、支持向量机、高斯过程和神经网络分类等方法进行精度评价。
resultsin 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)).
总共包括14个crc、64个aa、69个la、127个sa和227个c。第二个样本由32名息肉切除患者和32名c.粪便挥发性有机化合物（vocs）收集，它们区分了c（auc）（95%）：crc与c 0.96（0.89‐1）；aa与c 0.96（0.93‐1）；la与c 0.96（0.92‐0.99）；sa与c 0.96（0.94‐0.99）。结直肠癌组与腺瘤组之间无显著性差异。腺瘤患者和c患者在息肉切除术前进行鉴别，而息肉切除术后3个月voc曲线相似（t0腺瘤vs c 0.98（0.95‐1）；t1腺瘤vs c0.55（0.40‐0.69））
conclusionsfaecal 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.
粪便中挥发性有机化合物的分布可能有助于早期发现结直肠癌和腺瘤，息肉切除后监测息肉的时间可使挥发性有机化合物分布正常化。