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Evaluation of Fecal M2PK as a Diagnostic Marker in Colorectal Cancer

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Invasive colonoscopy is the gold standard for patients at risk for colorectal cancer. However, the need for non-invasive and specific markers is required.


To evaluate the sensitivity of the glycolytic pyruvate kinase isoenzyme type M2 dimer (M2PK) as a diagnostic biomarker for colorectal cancer (CRC) and adenomatous colorectal polyps (CRP) screening.




Twenty patients with CRC, 20 patients with CRP (lack criteria for colonic cancer by biopsy), and 20 normal subjects.


Complete blood count (CBC), erythrocyte sedimentation rate (ESR), tumor markers: carcino embryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9), fecal occult blood test (FOBT), and fecal M2PK. Pelvic and abdominal ultrasound (US), colonoscopy, and a histopathological examination.


Only weight loss and cachexia were significantly associated with CRC than CRP or control groups. M2PK was the most sensitive and specific test in differentiating CRC from CRP and the control subjects (sensitivity = 75%, specificity = 100%).


(1) The selection of cases for three well-matched groups, as to perform colonoscopy in well-prepared cases and conditions. (2) Replicates in more than 20 cases for confirmation at the expense of enrolling new patients. (3) The cost associated with tumor markers analysis.


Fecal M2PK can be used as a precolonoscopy screening test for CRC patients, and is superior to other tumor markers, and in indicating the progress of colorectal adenomas > 1 cm. Thus being cost-effective and easy-to-perform test, it is a feasible tool to preselect patients who require colonoscopy.

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analysis of variance


bleeding per rectum

CA 19-9 :

carbohydrate antigen 19-9


carcino embryonic antigen


colorectal (adenomatous) polyps


colorectal cancer

CT :

computerized tomography

Ctrl :


DA :

diagnostic accuracy

DM :

diabetes mellitus


enzyme-linked immunosorbent assay


erythrocyte sedimentation rate


fecal occult blood test




international normalized ratio

LR :

likelihood ratio


National Cancer Institute


negative predictive value


partial thromboplastin time

PT :

prothrombin time


positive predictive value

M2PK :

pyruvate kinase isoenzyme type M2


receiver operating characteristic


Statistical Package for Social Sciences


area under the curve


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All the authors contributed equally to conception, writing the manuscript, and the analysis of data included in this article. D.J. supported the Endnote X8 software required for this article.

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Correspondence to Dina Johar.

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The authors declare that they have no conflict of interest.

Ethical approval

The study ethics protocol was approved by the Tropical Medicine Department, Ain-Shams University and the Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute, Cairo, Egypt.

Consent to participate

Written consent to participate was given by all patients who were enrolled in the study.

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Dabbous, H.K., Mohamed, Y.AR., El-Folly, R.F. et al. Evaluation of Fecal M2PK as a Diagnostic Marker in Colorectal Cancer. J Gastrointest Canc 50, 442–450 (2019).

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