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BackgroundCRC:majorcauseofdeathanddiseaseBackgroundCRC:majorcauseof1BackgroundProcessesofcolorectalcarcinogenesislendthemselvestoscreeningBackgroundProcessesofcolorec2BackgroundAsubstantialproportionnevertested!ScreeningforCRCiscost-effectiveAsimple,noninvasivetestmightimproveclinicalout-comes28%Background28%3BackgroundColorectalcancerarisesfromaccumulatedgeneticandepigeneticalterationsBackgroundColorectalcancerar4AimEvaluatethemultitargetstoolDNAtestasatoolforscreeningAimEvaluatethemultitarg5AimPrimaryaim:DNAtestinthedetectionofCRCSecondaryaims:DNAtestinthedetectionofadvancedprecancerouslesionsandtocompareitwithacommerciallyavailablefecalimmunochemicaltest(FIT)DNAtestVSAimPrimaryaim:DNAtest6MethodsStudyPopulation:2011.6-2012.1190sites
AsymptomaticpersonsAgesof50to84ataverageriskforCRCScheduledtoundergoscreeningcolonoscopyMethodsStudyPopulation:Asympt7Secondaryaims:DNAtestinthedetectionofadvancedprecancerouslesionsandtocompareitwithacommerciallyavailablefecalimmunochemicaltest(FIT)Asimple,noninvasivetestmightimproveclinicalout-comesAsubstantialproportionnevertested!digestivecancer,orinflammatoryboweldiseasepreviouscolonoscopy,bariumenema,CT,sigmoidoscopyundergonecolorectalresectionAdvancedprecancerouslesions:Advancedadenomashigh-gradedysplasiafamilyhistorySessileserratedpolypsmeasuring1cmormoreindiameterundergonecolorectalresectionStudyPopulation:Agesof50to84ataverageriskforCRCpreviouscolonoscopy,bariumenema,CT,sigmoidoscopyConclusionsSessileserratedpolypsmeasuring1cmormoreindiameterCRC,stagedeterminedwiththeuseoftheAJCCstagingsystempositiveresultsonfecalbloodtesting,rectalbleedingSecondaryaims:DNAtestinthedetectionofadvancedprecancerouslesionsandtocompareitwithacommerciallyavailablefecalimmunochemicaltest(FIT)CRC,stagedeterminedwiththeuseoftheAJCCstagingsystemMethodsExcluded
personalhistory:colorectalneoplasia,digestivecancer,orinflammatoryboweldisease
previouscolonoscopy,bariumenema,CT,sigmoidoscopy
positiveresultsonfecalbloodtesting,rectalbleedingundergonecolorectalresectionfamilyhistorySecondaryaims:DNAtestinth8MethodsPrimaryandSecondaryOutcomesCRC,stagedeterminedwiththeuseoftheAJCCstagingsystem
Advancedprecancerouslesions:
Advancedadenomashigh-gradedysplasiawith≥25%villoushistologicfeaturesmeasure≥1cminthegreatestdimension
Sessileserratedpolypsmeasuring1cmormoreindiameterMethodsPrimaryandSecondaryO9aberrantlymethylatedBMP3andNDRG4promoterregionsmutantKRASimmunochemicalassayforhumanhemoglobinFITMultitargetstoolDNAtestaberrantlymethylatedBMP3and10Results127760.7%7.6%Results127760.7%7.6%11結(jié)腸癌英文文獻抄讀課件12ResultsResults13ResultsResults14ResultsFigure3.ReceiverOperatingCharacteristic(ROC)CurvesComparingDNATestingandFITfortheDetectionofColorectalCancerandAdvancedColorectalNeoplasia.ResultsFigure3.ReceiverOpera15ResultsMultitargetDNAtestingdetectedclinicallysignificantlesionsmoreefficientlythanFIT.ResultsMultitargetDNAtesting16ConclusionsAstooltestcombiningalteredhumanDNAandfecalhemoglobinshowedhighersensitivitythanacommercialFITforbothCRCandadvancedprecancerouslesions,althoughwithlowerspecificity.ConclusionsAstooltestcombin17TranslationalResearchAug.12,2014FDAApprovesCologuardFirstandOnlyStoolDNANoninvasiveColorectalCancerScreeningTestReceivedaproposedcove-ragememorandumfromtheCentersforMedicareandMedicaidServices(CMS)TranslationalResearchAug.12,18ProcessesofcolorectalcarcinogenesislendthemselvestoscreeningAdvancedprecancerouslesions:CRC,stagedeterminedwiththeuseoftheAJCCstagingsystem1190sitesundergonecolorectalresectionAdvancedprecancerouslesions:familyhistoryAstooltestcombiningalteredhumanDNAandfecalhemoglobinshowedhighersensitivitythanacommercialFITforbothCRCandadvancedprecancerouslesions,althoughwithlowerspecificity.positiveresultsonfecalbloodtesting,rectalbleedingpositiveresultsonfecalbloodtesting,rectalbleedingMultitargetstoolDNAtestMultitargetDNAtestingdetectedclinicallysignificantlesionsmoreefficientlythanFIT.Aneasy-to-usescreen-ingtestEvaluatethemultitargetstoolDNAtestasatoolforscreeningColorectalcancerarisesfromaccumulatedgeneticandepigeneticalterationsCRC,stagedeterminedwiththeuseoftheAJCCstagingsystempositiveresultsonfecalbloodtesting,rectalbleedingAsymptomaticpersonsAdvancedadenomashigh-gradedysplasiaColorectalcancerarisesfromaccumulatedgeneticandepigeneticalterationsStudyPopulation:PeopleataverageriskforcolorectalcancerAneasy-to-usescreen-ingtest599$Processesofcolorectalcarcin19結(jié)腸癌英文文獻抄讀課件20BackgroundAsubstantialproportionnevertested!ScreeningforCRCiscost-effectiveAsimple,noninvasivetestmightimproveclinicalout-comes28%Background28%21MethodsStudyPopulation:2011.6-2012.1190sites
AsymptomaticpersonsAgesof50to84ataverageriskforCRCScheduledtoundergoscreeningcolonoscopyMethodsStudyPopulation:Asympt22MethodsPrimaryandSecondaryOutcomesCRC,stagedeterminedwiththeuseoftheAJCCstagingsystem
Advancedprecancerouslesions:
Advancedadenomashigh-gradedysplasiawith≥25%villoushistologicfeaturesmeasure≥1cminthegreatestdimension
Sessileserratedpolypsmeasuring1cmormoreindiameterMethodsPrimaryandSecondaryO23ResultsFigure3.ReceiverOperatingCharacteristic(ROC)CurvesComparingDNATestingandFITfortheDetectionofColorectalCancerandAdvancedColorectalNeoplasia.ResultsFigure3.ReceiverOpera24ConclusionsAstooltestcombiningalteredhumanDNAandfecalhemoglobinshowedhighersensitivitythanacommercialFITforbothCRCandadvancedprecancerouslesions,althoughwithlowerspecificity.ConclusionsAstooltestcombin251190sitesAstooltestcombiningalteredhumanDNAandfecalhemoglobinshowedhighersensitivitythanacommercialFITforbothCRCandadvancedprecancerouslesions,althoughwithlowerspecificity.CRC,stagedeterminedwiththeuseoftheAJCCstagingsystemAsymptomaticpersonspositiveresultsonfecalbloodtesting,rectalbleedingdigestivecancer,orinflammatoryboweldiseaseAgesof50to84ataverageriskforCRCpreviouscolonoscopy,bariumenema,CT,sigmoidoscopyPrimaryandSecondaryOutcomesmeasure≥1cminthegreatestdimensionAdvancedadenomashigh-gradedysplasiaSessileserratedpolypsmeasuring1cmormoreindiameterCRC,stagedeterminedwiththeuseoftheAJCCstagingsystemFDAApprovesCologuardSecondaryaims:DNAtestinthedetectionofadvancedprecancerouslesionsandtocompareitwithacommerciallyavailablefecalimmunochemicaltest(FIT)Asimple,noninvasivetestmightimproveclinicalout-comespositiveresultsonfecalbloodtesting,rectalbleedingpositiveresultsonfecalbloodtesting,rectalbleedingPrimaryandSecondaryOutcomesScheduledtoundergoscreeningcolonoscopyAdvancedprecancerouslesions:ReceiverOperatingCharacteristic(ROC)CurvesComparingDNATestingandFITfortheDetectionofColorectalCancerandAdvancedColorectalNeoplasia.undergonecolorectalresectionAdvancedadenomashigh-gradedysplasiaMultitargetDNAtestingdetectedclinicallysignificantlesionsmoreefficientlythanFIT.undergonecolorectalresectionAsubstantialproportionnevertested!CRC,stagedeterminedwiththeuseoftheAJCCstagingsystemFDAApprovesCologuardCRC,stagedeterminedwiththeuseoftheAJCCstagingsystemCRC,stagedeterminedwiththeuseoftheAJCCstagingsystemCRC,stagedeterminedwiththeuseoftheAJCCstagingsystemwith≥25%villoushistologicfeaturesCRC,stagedeterminedwiththeuseoftheAJCCstagingsystemFirstandOnlyStoolDNANoninvasiveColorectalCancerScreeningTestSecondaryaims:DNAtestinthedetectionofadvancedprecancerouslesionsandtocompareitwithacommerciallyavailablefecalimmunochemicaltest(FIT)Sessileserratedpolypsmeasuring1cmormoreindiameterConclusionsdigestivecancer,orinflammatoryboweldiseasepersonalhistory:colorectalneoplasia,Advancedprecancerouslesions:Colorectalcancerarisesfromaccumulatedgeneticandepigeneticalterationspreviouscolonoscopy,bariumenema,CT,sigmoidoscopyPrimaryaim:DNAtestinthedetectionofCRCEvaluatethemultitargetstoolDNAtestasatoolforscreeningCRC,stagedeterminedwiththeuseoftheAJCCstagingsystempreviouscolonoscopy,bariumenema,CT,sigmoidoscopyPrimaryandSecondaryOutcomesAsymptomaticpersonsMultitargetDNAtestingdetectedclinicallysignificantlesionsmoreefficientlythanFIT.positiveresultsonfecalbloodtesting,rectalbleedingMultitargetstoolDNAtestpositiveresultsonfecalbloodtesting,rectalbleedingAsymptomaticpersonsfamilyhistoryAsubstantialproportionnevertested!Advancedprecancerouslesions:Processesofcolorectalcarcinogenesislendthemselvestoscreeningpositiveresultsonfecalbloodtesting,rectalbleedingPrimaryandSecondaryOutcomesMultitargetDNAtestingdetectedclinicallysignificantlesionsmoreefficientlythanFIT.Advancedprecancerouslesions:Advancedprecancerouslesions:measure≥1cminthegreatestdimensionAdvancedadenomashigh-gradedysplasiaPrimaryandSecondaryOutcomesdigestivecancer,orinflammatoryboweldiseaseSessileserratedpolypsmeasuring1cmormoreindiameterpositiveresultsonfecalbloodtesting,rectalbleedingCRC,stagedeterminedwiththeuseoftheAJCCstagingsystemundergonecolorectalresectionScreeningforCRCiscost-effectivewith≥25%villoushistologicfeaturesSecondaryaims:DNAtestinthedetectionofadvancedprecancerouslesionsandtocompareitwithacommerciallyavailablefecalimmunochemicaltest(FIT)Sessileserratedpolypsmeasuring1cmormoreindiameterCRC,stagedeterminedwiththeuseoftheAJCCstagingsystemAsymptomaticpersonsAsimple,noninvasivetestmightimproveclinicalout-comesTranslationalResearchpreviouscolonoscopy,bariumenema,CT,sigmoidoscopywith≥25%villoushistologicfeaturesAdvancedadenomashigh-gradedysplasiapositiveresultsonfecalbloodtesting,rectalbleedingmeasure≥1cminthegreatestdimensionPrimaryandSecondaryOutcomes1190sitesReceiverOpera26BackgroundCRC:majorcauseofdeathanddiseaseBackgroundCRC:majorcauseof27BackgroundProcessesofcolorectalcarcinogenesislendthemselvestoscreeningBackgroundProcessesofcolorec28BackgroundAsubstantialproportionnevertested!ScreeningforCRCiscost-effectiveAsimple,noninvasivetestmightimproveclinicalout-comes28%Background28%29BackgroundColorectalcancerarisesfromaccumulatedgeneticandepigeneticalterationsBackgroundColorectalcancerar30AimEvaluatethemultitargetstoolDNAtestasatoolforscreeningAimEvaluatethemultitarg31AimPrimaryaim:DNAtestinthedetectionofCRCSecondaryaims:DNAtestinthedetectionofadvancedprecancerouslesionsandtocompareitwithacommerciallyavailablefecalimmunochemicaltest(FIT)DNAtestVSAimPrimaryaim:DNAtest32MethodsStudyPopulation:2011.6-2012.1190sites
AsymptomaticpersonsAgesof50to84ataverageriskforCRCScheduledtoundergoscreeningcolonoscopyMethodsStudyPopulation:Asympt33Secondaryaims:DNAtestinthedetectionofadvancedprecancerouslesionsandtocompareitwithacommerciallyavailablefecalimmunochemicaltest(FIT)Asimple,noninvasivetestmightimproveclinicalout-comesAsubstantialproportionnevertested!digestivecancer,orinflammatoryboweldiseasepreviouscolonoscopy,bariumenema,CT,sigmoidoscopyundergonecolorectalresectionAdvancedprecancerouslesions:Advancedadenomashigh-gradedysplasiafamilyhistorySessileserratedpolypsmeasuring1cmormoreindiameterundergonecolorectalresectionStudyPopulation:Agesof50to84ataverageriskforCRCpreviouscolonoscopy,bariumenema,CT,sigmoidoscopyConclusionsSessileserratedpolypsmeasuring1cmormoreindiameterCRC,stagedeterminedwiththeuseoftheAJCCstagingsystempositiveresultsonfecalbloodtesting,rectalbleedingSecondaryaims:DNAtestinthedetectionofadvancedprecancerouslesionsandtocompareitwithacommerciallyavailablefecalimmunochemicaltest(FIT)CRC,stagedeterminedwiththeuseoftheAJCCstagingsystemMethodsExcluded
personalhistory:colorectalneoplasia,digestivecancer,orinflammatoryboweldisease
previouscolonoscopy,bariumenema,CT,sigmoidoscopy
positiveresultsonfecalbloodtesting,rectalbleedingundergonecolorectalresectionfamilyhistorySecondaryaims:DNAtestinth34MethodsPrimaryandSecondaryOutcomesCRC,stagedeterminedwiththeuseoftheAJCCstagingsystem
Advancedprecancerouslesions:
Advancedadenomashigh-gradedysplasiawith≥25%villoushistologicfeaturesmeasure≥1cminthegreatestdimension
Sessileserratedpolypsmeasuring1cmormoreindiameterMethodsPrimaryandSecondaryO35aberrantlymethylatedBMP3andNDRG4promoterregionsmutantKRASimmunochemicalassayforhumanhemoglobinFITMultitargetstoolDNAtestaberrantlymethylatedBMP3and36Results127760.7%7.6%Results127760.7%7.6%37結(jié)腸癌英文文獻抄讀課件38ResultsResults39ResultsResults40ResultsFigure3.ReceiverOperatingCharacteristic(ROC)CurvesComparingDNATestingandFITfortheDetectionofColorectalCancerandAdvancedColorectalNeoplasia.ResultsFigure3.ReceiverOpera41ResultsMultitargetDNAtestingdetectedclinicallysignificantlesionsmoreefficientlythanFIT.ResultsMultitargetDNAtesting42ConclusionsAstooltestcombiningalteredhumanDNAandfecalhemoglobinshowedhighersensitivitythanacommercialFITforbothCRCandadvancedprecancerouslesions,althoughwithlowerspecificity.ConclusionsAstooltestcombin43TranslationalResearchAug.12,2014FDAApprovesCologuardFirstandOnlyStoolDNANoninvasiveColorectalCancerScreeningTestReceivedaproposedcove-ragememorandumfromtheCentersforMedicareandMedicaidServices(CMS)TranslationalResearchAug.12,44ProcessesofcolorectalcarcinogenesislendthemselvestoscreeningAdvancedprecancerouslesions:CRC,stagedeterminedwiththeuseoftheAJCCstagingsystem1190sitesundergonecolorectalresectionAdvancedprecancerouslesions:familyhistoryAstooltestcombiningalteredhumanDNAandfecalhemoglobinshowedhighersensitivitythanacommercialFITforbothCRCandadvancedprecancerouslesions,althoughwithlowerspecificity.positiveresultsonfecalbloodtesting,rectalbleedingpositiveresultsonfecalbloodtesting,rectalbleedingMultitargetstoolDNAtestMultitargetDNAtestingdetectedclinicallysignificantlesionsmoreefficientlythanFIT.Aneasy-to-usescreen-ingtestEvaluatethemultitargetstoolDNAtestasatoolforscreeningColorectalcancerarisesfromaccumulatedgeneticandepigeneticalterationsCRC,stagedeterminedwiththeuseoftheAJCCstagingsystempositiveresultsonfecalbloodtesting,rectalbleedingAsymptomaticpersonsAdvancedadenomashigh-gradedysplasiaColorectalcancerarisesfromaccumulatedgeneticandepigeneticalterationsStudyPopulation:PeopleataverageriskforcolorectalcancerAneasy-to-usescreen-ingtest599$Processesofcolorectalcarcin45結(jié)腸癌英文文獻抄讀課件46BackgroundAsubstantialproportionnevertested!ScreeningforCRCiscost-effectiveAsimple,noninvasivetestmightimproveclinicalout-comes28%Background28%47MethodsStudyPopulation:2011.6-2012.1190sites
AsymptomaticpersonsAgesof50to84ataverageriskforCRCScheduledtoundergoscreeningcolonoscopyMethodsStudyPopulation:Asympt48MethodsPrimaryandSecondaryOutcomesCRC,stagedeterminedwiththeuseoftheAJCCstagingsystem
Advancedprecancerouslesions:
Advancedadenomashigh-gradedysplasiawith≥25%villoushistologicfeaturesmeasure≥1cminthegreatestdimension
Sessileserratedpolypsmeasuring1cmormoreindiameterMethodsPrimaryandSecondaryO49ResultsFigure3.ReceiverOperatingCharacteristic(ROC)CurvesComparingDNATestingandFITfortheDetectionofColorectalCancerandAdvancedColorectalNeoplasia.ResultsFigure3.ReceiverOpera50ConclusionsAstooltestcombiningalteredhumanDNAandfecalhemoglobinshowedhighersensitivitythanacommercialFITforbothCRCandadvancedprecancerouslesions,althoughwithlowerspecificity.ConclusionsAstooltestcombin511190sitesAstooltestcombiningalteredhumanDNAandfecalhemoglobinshowedhighersensitivitythanacommercialFITforbothCRCandadvancedprecancerouslesions,althoughwithlowerspecificity.CRC,stagedeterminedwiththeuseoftheAJCCstagingsystemAsymptomaticpersonspositiveresultsonfecalbloodtesting,rectalbleedingdigestivecancer,orinflammatoryboweldiseaseAgesof50to84ataverageriskforCRCpreviouscolonoscopy,bariumenema,CT,sigmoidoscopyPrimaryandSecondaryOutcomesmeasure≥1cminthegreatestdimensionAdvancedadenomashigh-gradedysplasiaSessileserratedpolypsmeasuring1cmormoreindiameterCRC,stagedeterminedwiththeuseoftheAJCCstagingsystemFDAApprovesCologuardSecondaryaims:DNAtestinthedetectionofadvancedprecancerouslesionsandtocompareitwithacommerciallyavailablefecalimmunochemicaltest(FIT)Asimple,noninvasivetestmightimproveclinicalout-comespositiveresultsonfecalbloodtesting,rectalbleedingpositiveresultsonfecalbloodtesting,rectalbleedingPrimaryandSecondaryOutcomesScheduledtoundergoscreeningcolonoscopyAdvancedprecancerouslesions:ReceiverOperatingCharacteristic(ROC)CurvesComparingDNATestingandFITfortheDetectionofColorectalCancerandAdvancedColorectalNeoplasia.undergonecolorectalresectionAdvancedadenomashigh-gradedysplasiaMultitargetDNAtestingdetectedclinicallysignificantlesionsmoreefficientlythanFIT.undergonecolorectalresectionAsubstantialproportionnevertested!CRC,stagedeterminedwiththeuseoftheAJCCstagingsystemFDAApprovesCologuardCRC,stagedeterminedwiththeuseoftheAJCCstagingsystemCRC,stagedeterminedwiththeuseoftheAJCCstagingsystemCRC,stagedeterminedwiththeuseoftheAJCCstagingsystemwith≥25%villoushistologicfeaturesCRC,stagedeterminedwiththeuseoftheAJCCstagingsystemFirstandOnlyStoolDNANoninvasiveColorectalCancerScreeningTestSecondaryaims:DNAtestinthedetectionofadvancedprecancerouslesionsandtocompareitwithacommerciallyavailablefecalimmunochemicaltest(FIT)Sessileserratedpolypsmeasuring1cmormoreindiameterConclusionsdigestivecancer,orinflammatoryboweldiseasepersonalhistory:colore
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