Abstract
PURPOSE: The study contained herein was undertaken to investigate fecal calprotectin excretion in a series of patients with colorectal carcinoma and to determine whether the excretion was influenced by localization or stage of the tumor. Furthermore, the effect of surgical treatment on the concentrations was studied. Fecal calprotectin was also compared with plasma concentrations of calprotectin, carcinoembryonic antigen, and C-reactive protein. METHODS: Fecal calprotectin was measured in 119 consecutive patients admitted for treatment of colorectal carcinoma. In 116 (97.5 percent) patients, resectional surgery was performed. Plasma calprotectin was measured in 90 (76 percent) patients, carcinoembryonic antigen in 88 (74 percent) patients, and C-reactive protein in 82 (69 percent) patients. RESULTS: Median fecal calprotectin concentration in the 119 patients was 50 (range, 2-950) mg/l, which was significantly (P<0.0001) higher than in 125 control patients (median, 5.2 mg/l). In 23 patients studied also after resection, the excretion fell greatly. There were no significant differences in fecal calprotectin concentration among patients with different tumor stages. Elevated plasma calprotectin concentrations were found in 67 of 90 (73.3 percent) patients with colorectal carcinoma, compared with elevated fecal calprotectin in 111 of 119 (93.3 percent) patients, and there was no significant correlation between plasma and fecal calprotectin concentrations. Plasma calprotectin concentrations were significantly lower in patients with T1 or T2 tumors than in those with more advanced stages (P=0.0025). CONCLUSION: Measurement of fecal calprotectin may become a diagnostic tool in detecting colorectal carcinoma. The specificity in relation to colorectal carcinoma has not, however, been completely investigated. Both neoplastic and inflammatory conditions may be associated with elevated values; therefore, it is unlikely that calprotectin can predict specific colonic disorders.
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References
Fagerhol MK, Dale I, Anderson I. Release and quantitation of leukocyte derived protein (L1). Scand J Haematol 1980;24:393–8.
Fagerhol MK, Anderson KB, Naess-Andresen CF, Brandzaeg P, Dale I. Calprotectin (the L1 leucocyte protein) In: Smith V, Dedman JR, eds. Stimulus response coupling: the role of intracellular calcium binding proteins. Boca Raton: CRC Press, 1990:87–210.
Dale I, Brandtzaeg P, Fagerhol MK, Scott H. Distribution of a new myelomonocytic antigen (L1) in human peripheral blood leukocytes: immunofluorescence and immunoperoxidase staining features in comparison with lysozyme and lactoferrin. Am J Clin Pathol 1985;84:24–34.
Berntzen HB, Fagerhol MK. L1, a major granulocyte protein: isolation of high quantities of its subunits. Scand J Clin Lab Invest 1990;50:769–74.
Roseth AG, Fagerhol MK, Aadland E, Schjonsby H. Assessment of the neutrophil dominating protein calprotectin in feces: a methodologic study. Scand J Gastroenterol 1992;27:793–8.
Roseth AG, Kristinsson J, Fagerhol MK,et al. Faecal calprotectin: a novel test for the diagnosis of colorectal cancer? Scand J Gastroenterol 1993;28:1073–6.
Gilbert JA, Ahlquist D, Mahony DW, Zinsmeister AR, Rubin J, Ellefson RD. Fecal marker variability in colorectal cancer: calprotectinversus hemoglobin. Scand J Gastroenterol 1996;31:1001–6.
Hermanek P, Sobin LH. TNM classification of malignant tumours. 4th ed. Berlin: Springer-Verlag, 1992.
Morson BC. Precancerous and early malignant lesions of the large intestine. Br J Surg 1968;55:725–31.
Dale I. Plasma levels of the calcium-binding L1 leukocyte protein: standardization of blood collection and evaluation of reference intervals in healthy controls. Scand J Clin Lab Invest 1990;50:837–41.
Bormer OP, Nustad K. Selection of monoclonal antibodies for use in an immunometric assay for carcinoembryonic antigen. J Immunol Methods 1990;127:171–8.
Meling GI, Rognum TO, Clausen OP,et al. Serum carcinoembryonic antigen in relation to survival, DNA ploidy pattern, and recurrent disease in 406 colorectal carcinoma patients. Scand J Gastroenterol 1992;27:1061–8.
Berntzen HB, Fagerhol MK, Ostensen M, Mowinckel P, Hoyeraal HM. The L1 protein as a new indicator of inflammatory activity in patients with juvenile rheumatoid arthritis. J Rheumatol 1991;18:133–8.
Berntzen HB, Munthe E, Fagerhol MK. A longitudinal study of the leukocyte protein L1 as an indicator of disease activity in patients with rheumatoid arthritis. J Rheumatol 1989;16:1416–20.
Berntzen HB, Fagerhol MK. L1, a major granulocyte protein: antigenic properties of its subunits. Scand J Clin Lab Invest 1988;48:647–52.
Sander J, Fagerhol MK, Bakken JS, Dale I. Plasma levels of the leucocyte L1 protein in febrile conditions: relation to aetiology, number of leucocytes in blood, blood sedimentation reaction and C-reactive protein. Scand J Clin Lab Invest 1984;44:357–62.
Carson DA, Lois A. Cancer progression and p53. Lancet 1995;346:1009–11.
Dale I, Brandtzaeg P. Expression of the epithelial L1 antigen as an immunohistochemical marker of squamous cell carcinoma of the lung. Histopathology 1989;14:493–502.
Kijlstra A, Broersma L. Lactoferrin stimulates the production of leucocyte migration inhibitory factor by human peripheral mononuclear leucocytes. Clin Exp Immunol 1984;55:459–64.
Saverymuttu SH, Maltby P, Batman P, Joseph AE, Maxwell D. False positive localisation of indium-111 granulocytes in colonic carcinoma. Br J Radiol 1986;59:773–7.
Bjerke K, Halstensen TS, Jahnsen F, Pulford K, Brandtzaeg P. Distribution of macrophages and granulocytes expressing L1 protein (calprotectin) in human Peyer's patches compared with normal ileal lamina propria and mesenteric lymph nodes. Gut 1993;34:1357–63.
Uchida K, Matsuse R, Tomita S, Sugi K, Saitoh O, Ohshiba S. Immunochemical detection of human lactoferrin in feces as a new marker for inflammatory gastrointestinal disorders and colon cancer. Clin Biochem 1994;27:259–64.
Becker W, Schaffer R, Borner W. Sigmoid carcinoma mimicking an intra-abdominal abscess in an 111Inlabeled white blood cell scan. Eur J Nucl Med 1985;11:283–4.
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Kristinsson, J., Røseth, A., Fagerhol, M.K. et al. Fecal calprotectin concentration in patients with colorectal carcinoma. Dis Colon Rectum 41, 316–321 (1998). https://doi.org/10.1007/BF02237485
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DOI: https://doi.org/10.1007/BF02237485