{"id":24937,"date":"2023-12-11T04:53:00","date_gmt":"2023-12-10T20:53:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=24937"},"modified":"2023-12-11T06:08:57","modified_gmt":"2023-12-10T22:08:57","slug":"jama-intern-med%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e7%b2%aa%e4%be%bf%e5%a4%9a%e9%9d%b6%e7%82%b9rna%e6%a3%80%e6%b5%8b%e7%ad%9b%e6%9f%a5%e7%bb%93%e7%9b%b4%e8%82%a0%e7%99%8c","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=24937","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u7caa\u4fbf\u591a\u9776\u70b9RNA\u68c0\u6d4b\u7b5b\u67e5\u7ed3\u76f4\u80a0\u764c"},"content":{"rendered":"\n<p>Original Investigation&nbsp;<\/p>\n\n\n\n<p>October&nbsp;23,&nbsp;2023<\/p>\n\n\n\n<h1 class=\"wp-block-heading\">Multitarget Stool RNA Test for Colorectal Cancer Screening<\/h1>\n\n\n\n<h3 class=\"wp-block-heading\">Erica K.&nbsp;Barnell,&nbsp;Elizabeth M.&nbsp;Wurtzler,&nbsp;Julie&nbsp;La Rocca,&nbsp;et al<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\"><em>JAMA.&nbsp;<\/em>Published online October 23, 2023. doi:10.1001\/jama.2023.22231<\/h3>\n\n\n\n<p><a><\/a>Key Points<\/p>\n\n\n\n<p><strong>Question<\/strong>&nbsp;&nbsp;What is the performance of the novel multitarget stool RNA (mt-sRNA) test (ColoSense) for individuals 45 years and older undergoing colorectal cancer screening?<\/p>\n\n\n\n<p><strong>Findings<\/strong>&nbsp;&nbsp;A pivotal prospective, cross-sectional clinical trial comprising 8920 eligible participants was used to evaluate the sensitivity and specificity of the mt-sRNA test compared with a colonoscopy. The sensitivity of the mt-sRNA test for detecting colorectal cancer was 94%, the sensitivity for detecting advanced adenomas was 46%, and the specificity for no lesions on colonoscopy was 88%.<\/p>\n\n\n\n<p><strong>Meaning<\/strong>&nbsp;&nbsp;The mt-sRNA test exhibited strong performance across all age groups, including those aged 45 years and older. The mt-sRNA test demonstrated high sensitivity for detecting colorectal neoplasia and achieved a similar level of specificity compared with other molecular diagnostic tests.<a><\/a><\/p>\n\n\n\n<p>Abstract<\/p>\n\n\n\n<p><strong>Importance<\/strong>&nbsp;&nbsp;Noninvasive tests for colorectal cancer screening must include sensitive detection of colorectal cancer and precancerous lesions. These tests must be validated for the intended-use population, which includes average-risk individuals 45 years or older.<\/p>\n\n\n\n<p><strong>Objective<\/strong>&nbsp;&nbsp;To evaluate the sensitivity and specificity of a noninvasive, multitarget stool RNA (mt-sRNA) test (ColoSense) test compared with results from a colonoscopy.<\/p>\n\n\n\n<p><strong>Design, Setting, and Participants<\/strong>&nbsp;&nbsp;This phase 3 clinical trial (CRC-PREVENT) was a blinded, prospective, cross-sectional study to support a premarket approval application for a class III medical device. A total of 8920 participants were identified online using social media platforms and enrolled from June 2021 to June 2022 using a decentralized nurse call center. All participants completed the mt-sRNA test, which incorporated a commercially available fecal immunochemical test (FIT), concentration of 8 RNA transcripts, and participant-reported smoking status. Stool samples were collected prior to participants completing a colonoscopy at their local endoscopy center. The mt-sRNA test results (positive or negative) were compared with index lesions observed on colonoscopy. Over the course of 12 months, individuals 45 years and older were enrolled in the clinical trial using the decentralized recruitment strategy. Participants were enrolled from 49 US states and obtained colonoscopies at more than 3800 different endoscopy centers.<\/p>\n\n\n\n<p><strong>Main Outcomes and Measures<\/strong>&nbsp;&nbsp;The primary outcomes included the sensitivity of the mt-sRNA test for detecting colorectal cancer and advanced adenomas and the specificity for no lesions on colonoscopy.<\/p>\n\n\n\n<p><strong>Results<\/strong>\u00a0\u00a0The mean (range) age of participants was 55 (45-90) years, with 4% self-identified as Asian, 11% as Black, and 7% as Hispanic. Of the 8920 eligible participants, 36 (0.40%) had colorectal cancer and 606 (6.8%) had advanced adenomas. The mt-sRNA test sensitivity for detecting colorectal cancer was 94%, sensitivity for detecting advanced adenomas was 46%, and specificity for no lesions on colonoscopy was 88%. The mt-sRNA test showed significant improvement in sensitivity for colorectal cancer (94% vs 78%; McNemar\u00a0<em>P<\/em>\u2009=\u2009.01) and advanced adenomas (46% vs 29%; McNemar\u00a0<em>P<\/em>\u2009&lt;\u2009.001) compared with results of the FIT.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jama\/939261\/joi230133f1_1698955741.52401.png?Expires=1704838271&amp;Signature=OtmihHa5qTZO0~FnL-8V5waJe5xI5RyhP6h3rzXJYf-ipce08DZv1W1rwy30I8bcmX7NzqiayaE970KXx9mN-OzTo7hNlIU7gk3E9DFUnCJiqiH6v4WFZNQTeCiM1kr~6wUkpduttiI6eE3lk2n3WTF0~qVtG6~29F89BUgXfywJFN89G49nVM1mzE-6MwpmabI8bvcENxAMX89Y1JmcoY0OB~FMbZMCCljjXTVUSnoR1ljLRbqORiugtbITJc3YrzitPxvl2HR0cGCuzyaDyLWipWuzC6sEQ2Dw0jcj2zenwjpgZQBCizoTud5EDlC1zzXEJtlJDNbfbiAscIO5jA__&amp;Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jama\/939261\/joi230133f2_1698955741.57755.png?Expires=1704838271&amp;Signature=HBpOXUaL4L0FoTXjZukGzwt7C3aIZ4Q~~hV9on1I43Xtg~a4fU7AnhLmhexMxTbFMuL0Ymvi5bi15mbhPvjU6~MOl0BirxGI2Yo4P~FmTjtvczZQPou3u-bgJfRffm5zPpegyQgzeYV7NeHvVllcXest~s-J24Zk9x13AvgO6ewlPW8pSVTJceDpqsmtu7nAnuSQTrZsXRyuIFFjmNcJs5Svvw~NgEnHbEQRqIDwncdQiKt3WbeW5DJMd5bSiES5sE1nSILgDs~fjfu0WmOQBLTnuhlOE5E4ZuVMZRNmnTrUDIhd44ZnTfoPI9VwjP2XRjqHT2BKAjWZDj4iWqE21g__&amp;Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jama\/939261\/joi230133t1_1698955741.5434.png?Expires=1704838271&amp;Signature=NVhboixxrI8qYov73~sBblwsh23WHdGmkzo8~wSlgRX0eJ4HkmcgR-xee1rWbrKW~06SeTJRM0LZM4PgwGI4kS~85WbIZrw4Sufj-~SUkbvqFBJDzK20ejC0HRIespd~VlnTdhc33x7hFbLhEKo32jnw7RHw~hLTYF321Mc5KuZWOIBXoyZZ7Kza2wi98R03mRfXX-n~mh-A52OUO~Wnrr-TWeUVVUoI813Te0AOXSYbhdhCUGij1nBx9PbJYD1fqZOFspQXnX~fxpydkQ4HlAhfXmN-SJPbHW5YZpHKCd~tdC4v5sHrM6xAZQYDNxvbEEI4q24nxhqd~KaWe~3~JQ__&amp;Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/jama\/939261\/joi230133t2_1698955741.55842.png?Expires=1704838271&amp;Signature=vM4lKQeSNI-rqJFlv-ckgch5iQaRm-ovTJ5vCTv9S0zuoiLblhXbTIzBtGN~ypj6iNnpoQhxyCOIKv6tay2cYoxLOVNSBiZ91ATz7AnzwvXAfXmmH3e-lrMMCklEVi7L3a1vho4ORVdtNt9VQpFG-66RxvXybWXb94lZzK8h~1aqYEXdpjtJoefwM6dPgEPU6MgiIFPAyW5vzIJolxlLDRlqNcfNZjxYy-BnQR1oJSCfals71it1wIbJchAN9FgmHcX7owLGDt695FHNQGi4g1xDJpHczElqBo~vagWiojXFXpklQiSQbz-wa6C9LY1kKM27X~hrsHJY9d5nZpT1Wg__&amp;Key-Pair-Id=APKAIE5G5CRDK6RD3PGA\" alt=\"\"\/><\/figure>\n\n\n\n<p><strong>Conclusions and Relevance<\/strong>&nbsp;&nbsp;In individuals 45 years and older, the mt-sRNA test showed high sensitivity for colorectal neoplasia (colorectal cancer and advanced adenoma) with significant improvement in sensitivity relative to the FIT. Specificity for no lesions on colonoscopy was comparable to existing molecular diagnostic tests.<\/p>\n\n\n\n<p><strong>Trial Registration<\/strong>&nbsp;&nbsp;ClinicalTrials.gov Identifier:&nbsp;<a href=\"https:\/\/clinicaltrials.gov\/study\/NCT04739722\">NCT04739722<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Original Investigation&nbsp; October&nbsp;23,&nbsp;2023 [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24937"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24937"}],"version-history":[{"count":3,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24937\/revisions"}],"predecessor-version":[{"id":25130,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24937\/revisions\/25130"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24937"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24937"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24937"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}