糞便基因甲基化對結直腸腫瘤診斷價值的Meta分析_《中國循證醫學雜志》

作者：

張虎 ^1,2 ,  朱尤慶 ^1,2 , 吳亞瓊 ³ , 郭毅 ⁴ , 齊健 ^1,2

1. 武漢大學中南醫院消化內科（武漢 430071）；2. 湖北省腸病醫學臨床研究中心，湖北省腸病重點實驗室（武漢 430071）；3. 皖南醫學院附屬弋磯山醫院（蕪湖 241001）；4. 武漢大學公共衛生學院流行病學教研室（武漢 430071）;

關鍵詞：

結直腸腫瘤大腸癌糞便甲基化系統評價 Meta分析診斷性試驗

DOI：

10.7507/1672-2531.20130027

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　系統評價糞便基因異常甲基化診斷結直腸腫瘤的準確性。
方法　計算機檢索The Cochrane Library、PubMed、EMbase、CBM、Web of Science、CNKI和WanFang Data，收集糞便基因甲基化診斷結直腸腫瘤的研究，檢索時限為1990年1月至2012年2月，同時依據QUADAS條目評價納入研究質量，采用Meta-Disc1.4軟件進行數據分析。
結果　最終共納入32個研究，3 951例患者。Meta分析結果顯示：糞便基因甲基化對于檢測結直腸腫瘤的合并敏感度（Sen）、特異度（Spe）、診斷比值比（DOR）、SROC曲線下面積（AUC）及Q值分別為92%［95%CI（91%，93%）］、63%［95%CI（61%，65%）］、20.79［95%CI（15.13，28.57）］、0.861 9（SE=0.020 4）及0.792 6（SE=0.019 8）；對于檢測結直腸癌的合并Sen、Spe及SROC AUC分別為91%［95%CI（89%，92%）］、75%［95%CI（73%，77%）］及0.9007；而對于結直腸腺瘤的合并Sen、Spe及SROC AUC分別為79%［95%CI（76%，83%）］、75%［95%CI（73%，77%）］及0.845 7。
結論　糞便基因異常甲基化對于診斷結直腸腫瘤具有較高的敏感性（92%）和中度特異性（63%），可作為診斷結直腸腫瘤的無創性初篩方法。

引用本文： 張虎,朱尤慶,吳亞瓊,郭毅,齊健. 糞便基因甲基化對結直腸腫瘤診斷價值的Meta分析. 中國循證醫學雜志, 2013, 13(2): 149-159. doi: 10.7507/1672-2531.20130027 復制

1. Center MM, Jemal A, Ward E. International trends in colorectal cancer incidence rates. Cancer Epidemiol Biomarkers Prev, 2009, 18(6): 1688-1694.

2. Kohler BA, Ward E, Mccarthy BJ, et al. Annual report to the nation on the status of cancer, 1975-2007, featuring tumors of the brain and other nervous system. J Natl Cancer Inst, 2011, 103(9): 714-736.

3. Jemal A, Siegel R, Xu J, et al. Cancer statistics, 2010. CA Cancer J Clin, 2010, 60(5): 277-300.

4. 中華醫學會消化病學分會. 中國結直腸腫瘤篩查、早診早治和綜合預防共識意見. 胃腸病學, 2011, 16(11): 666-675.

5. Gumaste VV. CT colonography can be an adjunct to optical colonoscopy in CRC screening. Dig Dis Sci, 2009, 54(2): 212-217.

6. Chen WD, Han ZJ, Skoletsky J, et al. Detection in fecal DNA of colon cancer-specific methylation of the nonexpressed vimentin gene. Journal of the National Cancer Institute, 2005, 97(15): 1124-1132.

7. Olson J, Whitney DH, Durkee K, et al. DNA stabilization is critical for maximizing performance of fecal DNA-based colorectal cancer tests. Diagnostic Molecular Pathology, 2005, 14(3): 183-191.

8. Altekruse SF, Kosary CL, Krapcho M, et al. SEER Cancer Statistics Review 2009, 2009.

9. Whiting P, Rutjes AW, Reitsma JB, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodology, 2003, 3: 25.

10. Ahlquist DA, Taylor WR, Mahoney DW, et al. The stool DNA test is more accurate than the plasma septin 9 test in detecting colorectal neoplasia. Clin Gastroenterol Hepatol, 2012, 10(3): 272-277.

11. Bosch L, Oort FA, Neerincx M, et al. DNA methylation of phosphatase and actin regulator 3 detects colorectal cancer in stool and complements FIT. Cancer Prevention Research, 2012, 5(3): 464-472.

12. Ahlquist DA, Zou HZ, Domanico M, et al. Next generation stool DNA test accurately detects colorectal cancer and large adenomas. Gastroenterology, 2012, 142(2): 248-256.

13. Azuara D, Rodriguez-Moranta F, Biondo S, et al. Novel methylation panel for the early detection of colorectal tumors in stool DNA. Clin Colorectal Cancer, 2010, 9(3): 168-176.

14. Tang D, Liu J, Wang DR, et al. Diagnostic and prognostic value of the methylation status of secreted frizzled-related protein 2 in colorectal cancer. Clin Invest Med, 2011, 34(2): E88-E95.

15. Baek YH, Chang E, Kim YJ, et al. Stool methylation specific polymerase chain reaction assay for the detection of colorectal neoplasia in Korean patients. Dis Colon Rectum, 2009, 52(8): 1452-1463.

16. Li M, Chen WD, Papadopoulos N, et al. Sensitive digital quantification of DNA methylation in clinical samples. Nat Biotechnol, 2009, 27(9): 858-863.

17. Melotte V, Lentjes MH, Bosch SM, et al. N-Myc downstream-regulated gene 4 (NDRG4): a candidate tumor suppressor gene and potential biomarker for colorectal cancer. J Natl Cancer Inst, 2009, 101(13): 916-927.

18. Ausch C, Kim YH, Tsuchiya KD, et al. Comparative analysis of PCR based biomarker assay methods for colorectal polyp detection from fecal DNA. Clinical Chemistry, 2009, 55(8): 1559-1563.

19. Hellebrekers DM, Lentjes MH, Bosch SM, et al. GATA4 and GATA5 are potential tumor suppressors and biomarkers in colorectal cancer. Clin Cancer Res, 2009, 15(12): 3990-3997.

20. Mayor R, Casadome L, Azuara D, et al. Long range epigenetic silencing at 2q14.2 affects most human colorectal cancers and may have application as a non-invasive biomarker of disease. Br J Cancer, 2009, 100(10): 1534-1539.

21. Kim MS, Louwagie J, Carvalho B, et al. Promoter DNA methylation of oncostatin M receptor-beta as a novel diagnostic and therapeutic marker in ccolon cancer. Plos One, 2009, 4(e65558).

22. Nagasaka T, Tanaka N, Cullings HM, et al. Analysis of fecal DNA methylation to detect gastrointestinal neoplasia. Journal of the National Cancer Institute, 2009, 101(18): 1244-1258.

23. Glockner SC, Dhir M, Yi JM, et al. Methylation of TFPI2 in stool DNA: a potential novel biomarker for the detection of colorectal cancer. Cancer Res, 2009, 69(11): 4691-4699.

24. Wang DR, Tang D. Hypermethylated SFRP2 gene in fecal DNA is a high potential biomarker for colorectal cancer noninvasive screening. World J Gastroenterol, 2008, 14(4): 524-531.

25. Oberwalder M, Zitt M, Wontner C, et al. SFRP2 methylation in fecal DNA--a marker for colorectal polyps. Int J Colorectal Dis, 2008, 23(1): 15-19.

26. Itzkowitz S, Brand R, Jandorf L, et al. A simplified, noninvasive stool DNA test for colorectal cancer detection. Am J Gastroenterol, 2008, 103(11): 2862-2870.

27. Huang ZH, Li LH, Yang F, et al. Detection of aberrant methylation in fecal DNA as a molecular screening tool for colorectal cancer and precancerous lesions. World J Gastroenterol, 2007, 13(6): 950-954.

28. Itzkowitz SH, Jandorf L, Brand R, et al. Improved fecal DNA test for colorectal cancer screening. Clin Gastroenterol Hepatol, 2007, 5(1): 111-117.

29. Abbaszadegan MR, Tavasoli A, Velayati A, et al. Stool-based DNA testing, a new noninvasive method for colorectal cancer screening, the first report from Iran. World J Gastroenterol, 2007, 13(10): 1528-1533.

30. Zhang W, Bauer M, Croner R S, et al. DNA stool test for colorectal cancer: hypermethylation of the secreted frizzled-related protein-1 gene. Dis Colon Rectum, 2007, 50(10): 1618-1627.

31. Leung WK, To KF, Man EP, et al. Detection of hypermethylated DNA or cyclooxygenase-2 messenger RNA in fecal samples of patients with colorectal cancer or polyps. Am J Gastroenterol, 2007, 102(5): 1070-1076.

32. Petko Z, Ghiassi M, Shuber A, et al. Aberrantly methylated CDKN2A, MGMT, and MLH1 in colon polyps and in fecal DNA from patients with colorectal polyps. Clin Cancer Res, 2005, 11(3): 1203-1209.

33. Lenhard K, Bommer GT, Asutay S, et al. Analysis of promoter methylation in stool: a novel method for the detection of colorectal cancer. Clin Gastroenterol Hepatol, 2005, 3(2): 142-149.

34. Chen WD, Han ZJ, Skoletsky J, et al. Detection in fecal DNA of colon cancer-specific methylation of the nonexpressed vimentin gene. J Natl Cancer Inst, 2005, 97(15): 1124-1132.

35. Muller HM, Oberwalder M, Fiegl H, et al. Methylation changes in faecal DNA: a marker for colorectal cancer screening? Lancet, 2004, 363(9417): 1283-1285.

36. 徐梅華, 蔡克銀, 涂穎. 糞便基因甲基化分析對大腸癌的早期診斷價值. 臨床消化病雜志, 2012, 24(1): 17-19.

37. 康燕平, 曹付傲, 常文軍, 等. 糞便基因甲基化檢測在結直腸癌及其癌前病變篩查中的作用. 中華胃腸外科雜志, 2011, 14(1): 52-56.

38. 張金平, 王靜, 桂銀莉, 等. 人糞便中基因甲基化分析在大腸癌早期篩查中的意義. 中華醫學雜志, 2011, 91(35): 2482-2484.

39. 付蕾, 盛劍秋, 孟曉明, 等. 糞便DNA的Vimentin基因甲基化檢測在結直腸癌患者早期診斷中的意義. 胃腸病學和肝病學雜志, 2010, 19(7): 601-603.

40. 凌志安, 陳利生, 何純剛. 糞便p16基因甲基化狀態在結直腸癌早期診斷的意義. 結直腸肛門外科, 2009, 15(3): 144-148.

41. 黃朝暉, 李莉華, 楊帆, 等. 糞便DNA甲基化分析在結直腸癌診斷中的應用價值. 中華檢驗醫學雜志, 2007, 30(6): 617-620.

42. Hol L, Van Leerdam ME, Van Ballegooijen M, et al. Screening for colorectal cancer; randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy. Gut, 2010, 59(1): 62-68.

43. Tagore KS, Levin TR, Lawson MJ. The evolution to stool DNA testing for colorectal cancer. Alimentary Pharmacology and Therapeutics, 2004, 19(12): 1225-1233,.

44. Bourke MJ. Making every colonoscopy count: Ensuring quality in endoscopy. J Gastroenterol Hepatol, 2009, 24(Suppl 3): S43-50.

45. Ahlquist DA. Molecular detection of colorectal neoplasia. Gastroenterology, 2010, 138(6): 2127-2139.

46. 齊健, 朱尤慶, 李霞, 等. 不同階段結直腸腫瘤分泌型卷曲相關蛋白基因甲基化及表達. 中華消化雜志, 2007, 27(4): 251-254.

47. Qi J, Zhu YQ, Luo J, et al. Hypermethylation and expression regulation of secreted frizzled-related protein genes in colorectal tumor. World J Gastroenterology, 2006, 12(44): 7113-7117.

48. Qi J, Zhu YQ. Targeting the most upstream site of Wnt signaling pathway provides a strategic advantage for therapy in colorectal cancer. Curr Drug Targets, 2008, 9(7): 548-557.

49. Issa JP, Ahuja N, Toyota M, et al. Accelerated age-related CpG island methylation in ulcerative colitis. Cancer Res, 2001, 61(9): 3573-3577.

50. Lichtenstein P, Holm NV, Verkasalo PK, et al. Environmental and heritable factors in the causation of cancer--analyses of cohorts of twins from Sweden, Denmark, and Finland. N Engl J Med, 2000, 343(2): 78-85.

51. Hsieh CJ, Klump B, Holzmann K, et al. Hypermethylation of the p16INK4a promoter in colectomy specimens of patients with long-standing and extensive ulcerative colitis. Cancer Res, 1998, 58(17): 3942-3945.

52. Issa JP, Ottaviano YL, Celano P, et al. Methylation of the oestrogen receptor CpG island links ageing and neoplasia in human colon. Nat Genet, 1994, 7(4): 536-540.

53. Suzuki K, Suzuki I, Leodolter A, et al. Global DNA demethylation in gastrointestinal cancer is age dependent and precedes genomic damage. Cancer Cell, 2006, 9(3): 199-207.

1. Center MM, Jemal A, Ward E. International trends in colorectal cancer incidence rates. Cancer Epidemiol Biomarkers Prev, 2009, 18(6): 1688-1694.

2. Kohler BA, Ward E, Mccarthy BJ, et al. Annual report to the nation on the status of cancer, 1975-2007, featuring tumors of the brain and other nervous system. J Natl Cancer Inst, 2011, 103(9): 714-736.

3. Jemal A, Siegel R, Xu J, et al. Cancer statistics, 2010. CA Cancer J Clin, 2010, 60(5): 277-300.

4. 中華醫學會消化病學分會. 中國結直腸腫瘤篩查、早診早治和綜合預防共識意見. 胃腸病學, 2011, 16(11): 666-675.

5. Gumaste VV. CT colonography can be an adjunct to optical colonoscopy in CRC screening. Dig Dis Sci, 2009, 54(2): 212-217.

6. Chen WD, Han ZJ, Skoletsky J, et al. Detection in fecal DNA of colon cancer-specific methylation of the nonexpressed vimentin gene. Journal of the National Cancer Institute, 2005, 97(15): 1124-1132.

7. Olson J, Whitney DH, Durkee K, et al. DNA stabilization is critical for maximizing performance of fecal DNA-based colorectal cancer tests. Diagnostic Molecular Pathology, 2005, 14(3): 183-191.

8. Altekruse SF, Kosary CL, Krapcho M, et al. SEER Cancer Statistics Review 2009, 2009.

9. Whiting P, Rutjes AW, Reitsma JB, et al. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodology, 2003, 3: 25.

10. Ahlquist DA, Taylor WR, Mahoney DW, et al. The stool DNA test is more accurate than the plasma septin 9 test in detecting colorectal neoplasia. Clin Gastroenterol Hepatol, 2012, 10(3): 272-277.

11. Bosch L, Oort FA, Neerincx M, et al. DNA methylation of phosphatase and actin regulator 3 detects colorectal cancer in stool and complements FIT. Cancer Prevention Research, 2012, 5(3): 464-472.

12. Ahlquist DA, Zou HZ, Domanico M, et al. Next generation stool DNA test accurately detects colorectal cancer and large adenomas. Gastroenterology, 2012, 142(2): 248-256.

13. Azuara D, Rodriguez-Moranta F, Biondo S, et al. Novel methylation panel for the early detection of colorectal tumors in stool DNA. Clin Colorectal Cancer, 2010, 9(3): 168-176.

14. Tang D, Liu J, Wang DR, et al. Diagnostic and prognostic value of the methylation status of secreted frizzled-related protein 2 in colorectal cancer. Clin Invest Med, 2011, 34(2): E88-E95.

15. Baek YH, Chang E, Kim YJ, et al. Stool methylation specific polymerase chain reaction assay for the detection of colorectal neoplasia in Korean patients. Dis Colon Rectum, 2009, 52(8): 1452-1463.

16. Li M, Chen WD, Papadopoulos N, et al. Sensitive digital quantification of DNA methylation in clinical samples. Nat Biotechnol, 2009, 27(9): 858-863.

17. Melotte V, Lentjes MH, Bosch SM, et al. N-Myc downstream-regulated gene 4 (NDRG4): a candidate tumor suppressor gene and potential biomarker for colorectal cancer. J Natl Cancer Inst, 2009, 101(13): 916-927.

18. Ausch C, Kim YH, Tsuchiya KD, et al. Comparative analysis of PCR based biomarker assay methods for colorectal polyp detection from fecal DNA. Clinical Chemistry, 2009, 55(8): 1559-1563.

19. Hellebrekers DM, Lentjes MH, Bosch SM, et al. GATA4 and GATA5 are potential tumor suppressors and biomarkers in colorectal cancer. Clin Cancer Res, 2009, 15(12): 3990-3997.

20. Mayor R, Casadome L, Azuara D, et al. Long range epigenetic silencing at 2q14.2 affects most human colorectal cancers and may have application as a non-invasive biomarker of disease. Br J Cancer, 2009, 100(10): 1534-1539.

21. Kim MS, Louwagie J, Carvalho B, et al. Promoter DNA methylation of oncostatin M receptor-beta as a novel diagnostic and therapeutic marker in ccolon cancer. Plos One, 2009, 4(e65558).

22. Nagasaka T, Tanaka N, Cullings HM, et al. Analysis of fecal DNA methylation to detect gastrointestinal neoplasia. Journal of the National Cancer Institute, 2009, 101(18): 1244-1258.

23. Glockner SC, Dhir M, Yi JM, et al. Methylation of TFPI2 in stool DNA: a potential novel biomarker for the detection of colorectal cancer. Cancer Res, 2009, 69(11): 4691-4699.

24. Wang DR, Tang D. Hypermethylated SFRP2 gene in fecal DNA is a high potential biomarker for colorectal cancer noninvasive screening. World J Gastroenterol, 2008, 14(4): 524-531.

25. Oberwalder M, Zitt M, Wontner C, et al. SFRP2 methylation in fecal DNA--a marker for colorectal polyps. Int J Colorectal Dis, 2008, 23(1): 15-19.

26. Itzkowitz S, Brand R, Jandorf L, et al. A simplified, noninvasive stool DNA test for colorectal cancer detection. Am J Gastroenterol, 2008, 103(11): 2862-2870.

27. Huang ZH, Li LH, Yang F, et al. Detection of aberrant methylation in fecal DNA as a molecular screening tool for colorectal cancer and precancerous lesions. World J Gastroenterol, 2007, 13(6): 950-954.

28. Itzkowitz SH, Jandorf L, Brand R, et al. Improved fecal DNA test for colorectal cancer screening. Clin Gastroenterol Hepatol, 2007, 5(1): 111-117.

29. Abbaszadegan MR, Tavasoli A, Velayati A, et al. Stool-based DNA testing, a new noninvasive method for colorectal cancer screening, the first report from Iran. World J Gastroenterol, 2007, 13(10): 1528-1533.

30. Zhang W, Bauer M, Croner R S, et al. DNA stool test for colorectal cancer: hypermethylation of the secreted frizzled-related protein-1 gene. Dis Colon Rectum, 2007, 50(10): 1618-1627.

31. Leung WK, To KF, Man EP, et al. Detection of hypermethylated DNA or cyclooxygenase-2 messenger RNA in fecal samples of patients with colorectal cancer or polyps. Am J Gastroenterol, 2007, 102(5): 1070-1076.

32. Petko Z, Ghiassi M, Shuber A, et al. Aberrantly methylated CDKN2A, MGMT, and MLH1 in colon polyps and in fecal DNA from patients with colorectal polyps. Clin Cancer Res, 2005, 11(3): 1203-1209.

33. Lenhard K, Bommer GT, Asutay S, et al. Analysis of promoter methylation in stool: a novel method for the detection of colorectal cancer. Clin Gastroenterol Hepatol, 2005, 3(2): 142-149.

34. Chen WD, Han ZJ, Skoletsky J, et al. Detection in fecal DNA of colon cancer-specific methylation of the nonexpressed vimentin gene. J Natl Cancer Inst, 2005, 97(15): 1124-1132.

35. Muller HM, Oberwalder M, Fiegl H, et al. Methylation changes in faecal DNA: a marker for colorectal cancer screening? Lancet, 2004, 363(9417): 1283-1285.

36. 徐梅華, 蔡克銀, 涂穎. 糞便基因甲基化分析對大腸癌的早期診斷價值. 臨床消化病雜志, 2012, 24(1): 17-19.

37. 康燕平, 曹付傲, 常文軍, 等. 糞便基因甲基化檢測在結直腸癌及其癌前病變篩查中的作用. 中華胃腸外科雜志, 2011, 14(1): 52-56.

38. 張金平, 王靜, 桂銀莉, 等. 人糞便中基因甲基化分析在大腸癌早期篩查中的意義. 中華醫學雜志, 2011, 91(35): 2482-2484.

39. 付蕾, 盛劍秋, 孟曉明, 等. 糞便DNA的Vimentin基因甲基化檢測在結直腸癌患者早期診斷中的意義. 胃腸病學和肝病學雜志, 2010, 19(7): 601-603.

40. 凌志安, 陳利生, 何純剛. 糞便p16基因甲基化狀態在結直腸癌早期診斷的意義. 結直腸肛門外科, 2009, 15(3): 144-148.

41. 黃朝暉, 李莉華, 楊帆, 等. 糞便DNA甲基化分析在結直腸癌診斷中的應用價值. 中華檢驗醫學雜志, 2007, 30(6): 617-620.

42. Hol L, Van Leerdam ME, Van Ballegooijen M, et al. Screening for colorectal cancer; randomised trial comparing guaiac-based and immunochemical faecal occult blood testing and flexible sigmoidoscopy. Gut, 2010, 59(1): 62-68.

43. Tagore KS, Levin TR, Lawson MJ. The evolution to stool DNA testing for colorectal cancer. Alimentary Pharmacology and Therapeutics, 2004, 19(12): 1225-1233,.

44. Bourke MJ. Making every colonoscopy count: Ensuring quality in endoscopy. J Gastroenterol Hepatol, 2009, 24(Suppl 3): S43-50.

45. Ahlquist DA. Molecular detection of colorectal neoplasia. Gastroenterology, 2010, 138(6): 2127-2139.

46. 齊健, 朱尤慶, 李霞, 等. 不同階段結直腸腫瘤分泌型卷曲相關蛋白基因甲基化及表達. 中華消化雜志, 2007, 27(4): 251-254.

47. Qi J, Zhu YQ, Luo J, et al. Hypermethylation and expression regulation of secreted frizzled-related protein genes in colorectal tumor. World J Gastroenterology, 2006, 12(44): 7113-7117.

48. Qi J, Zhu YQ. Targeting the most upstream site of Wnt signaling pathway provides a strategic advantage for therapy in colorectal cancer. Curr Drug Targets, 2008, 9(7): 548-557.

49. Issa JP, Ahuja N, Toyota M, et al. Accelerated age-related CpG island methylation in ulcerative colitis. Cancer Res, 2001, 61(9): 3573-3577.

50. Lichtenstein P, Holm NV, Verkasalo PK, et al. Environmental and heritable factors in the causation of cancer--analyses of cohorts of twins from Sweden, Denmark, and Finland. N Engl J Med, 2000, 343(2): 78-85.

51. Hsieh CJ, Klump B, Holzmann K, et al. Hypermethylation of the p16INK4a promoter in colectomy specimens of patients with long-standing and extensive ulcerative colitis. Cancer Res, 1998, 58(17): 3942-3945.

52. Issa JP, Ottaviano YL, Celano P, et al. Methylation of the oestrogen receptor CpG island links ageing and neoplasia in human colon. Nat Genet, 1994, 7(4): 536-540.

53. Suzuki K, Suzuki I, Leodolter A, et al. Global DNA demethylation in gastrointestinal cancer is age dependent and precedes genomic damage. Cancer Cell, 2006, 9(3): 199-207.

上一篇
多排螺旋CT泌尿系統造影三維重建技術診斷上尿路疾病的ROC分析

下一篇
磁共振成像診斷肺栓塞價值的Meta分析

1資料與方法

1.1一般資料

1.2方法

1.3察指標和判定標準

1.4統計學方法

2結果

2.1兩組患者療效比較

2.2兩組患者換藥次數、導管留置時間、治愈時間比較

2.3兩組患者治療前后血清PCT、CRP、WBC水平比較

3討論

《中國循證醫學雜志》

糞便基因甲基化對結直腸腫瘤診斷價值的Meta分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

1.	Center MM, Jemal A, Ward E. International trends in colorectal cancer incidence rates. Cancer Epidemiol Biomarkers Prev, 2009, 18(6): 1688-1694.
2.	Kohler BA, Ward E, Mccarthy BJ, et al. Annual report to the nation on the status of cancer, 1975-2007, featuring tumors of the brain and other nervous system. J Natl Cancer Inst, 2011, 103(9): 714-736.
3.	Jemal A, Siegel R, Xu J, et al. Cancer statistics, 2010. CA Cancer J Clin, 2010, 60(5): 277-300.
4.	中華醫學會消化病學分會. 中國結直腸腫瘤篩查、早診早治和綜合預防共識意見. 胃腸病學, 2011, 16(11): 666-675.
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糞便基因甲基化對結直腸腫瘤診斷價值的Meta分析

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