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Accuracy of the Discriminatory Ability of Combined Fecal Microbiota Panel in the Early Detection of Patients with Colorectal Cancer

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Abstract

Background

Colorectal cancer (CRC) screening and detecting it at an early stage is an effective way to decrease mortality from CRC. Colonoscopy, considered the gold standard (GS) for diagnosing the disease in many countries, has several limitations. Therefore, the main focus of this literature is to investigate the ability of combining candidate gut microbiota for early diagnosis of CRC, both in the presence and absence of GS test outcomes.

Methods

We analyzed the data derived from a case-control study, including 83 screening colonoscopies conducted on subjects aged 18–92 years in Tehran, Iran. The candidate gut microbiota including, ETBF, Enterococcus faecalis, and Porphyromonas gingivalis were quantified in samples using absolute qRT PCR. The Bayesian latent class model (LCM) was employed to combine the values from the multiple bacterial markers in order to optimize the discriminatory ability compared with a single marker.

Results

Based on Bayesian logistic regression, we discovered that family history of CRC, physical activity, cigarette smoking, and food diet were all significantly associated with an increased risk of CRC. When comparing ETBF and E. faecalis to P. gingivalis, we have observed that P. gingivalis exhibited greater predictive power in detecting high-risk individuals with CRC. As such, the sensitivity, specificity, and the area under the receiver-operating characteristics curve of combining ETBF, E. faecalis, and P. gingivalis were 98%, 96%, and 0.97, respectively.

Conclusions

This study suggests that the combined use of the three markers markedly improves classification performance compared to pairwise combinations, as well as individual markers, both with and without GS test outcomes. Noticeably, the triple composition of the fecal markers may serve as a reliable non-invasive indicator for the early prediction of CRC.

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Availability of Data and Materials

The datasets generated during and analyzed during the current study are not publicly available due to privacy of the study project but are available from the corresponding author on reasonable request.

Abbreviations

CRC:

Colorectal cancer

gFOBT:

Guaiac-based fecal occult blood test

FIT:

Fecal immunochemical test

GS:

Gold standard

ETBF:

Enterotoxigenic Bacteroides fragilis

P. gingivalis :

Porphyromonas gingivalis

E. faecalis :

Enterococcus faecalis

AUC:

Area under the curve

LCM:

Latent class model

ROC:

Receiver operating characteristic

SD:

Standard deviation

MCMC:

Markov chain Monte Carlo

CrI:

Credible interval

OR:

Odds ratio

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Acknowledgements

The authors would like to express their gratitude to Gastroenterology and Liver Diseases Research Center of Shahid Beheshti University of Medical Sciences for the facilitation of the process to conduct this study.

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Authors and Affiliations

  1. Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Maedeh Amini & Hamid Asadzadeh Aghdaei

  2. Section Mass Spectrometry and Proteomics, Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany

    Sama Rezasoltani

  3. Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Mohamad Amin Pourhoseingholi & Mohammad Reza Zali

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  1. Maedeh Amini
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Contributions

Conceptualization, methodology, software, formal analysis, investigation, resources, responsible for data, data curation, writing—original draft preparation, writing—review and editing, and supervision: MA. Data collection: SR and HAA. All authors reviewed and agreed to the published version of the manuscript.

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Correspondence to Maedeh Amini.

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Ethics Approval and Consent to Participate

This work is based upon research funded by Iran National Science Foundation (INSF) under project No. 99019094. Written informed consent was obtained from each subject enrolled into the study. All methods were carried out in accordance with relevant guidelines and regulations. In addition, we confirm that the experimental protocol was approved by the clinical research ethics committee of the Shahid Beheshti University of Medical Sciences and the ethics committee of Taleghani Hospital in Tehran, Iran.

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The authors declare no competing interests.

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Amini, M., Rezasoltani, S., Asadzadeh Aghdaei, H. et al. Accuracy of the Discriminatory Ability of Combined Fecal Microbiota Panel in the Early Detection of Patients with Colorectal Cancer. J Gastrointest Canc 55, 332–343 (2024). https://doi.org/10.1007/s12029-023-00962-z

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