The stool syndecan2 methylation test is more robust than blood tests for methylated septin9, CEA, CA19-9 and CA724 - a diagnostic test for the early detection of colorectal neoplasms

Sep 24, 2026

Evaluates the clinical performance of a stool methylated syndecan2 (mSDC2) assay for detecting colorectal neoplasms and compares it with blood-based methylated septin9 (mSEPT9) and tumor markers CEA, CA19-9 and CA724. Stool DNA was analyzed by bisulfite conversion and real-time quantitative methylation-specific PCR, while blood markers were measured using Epi proColon 2.0 and electrochemiluminescence. Results show higher detection rates and AUC for mSDC2 in CRC and adenoma, supporting improved strategies for colorectal cancer prevention and early detection.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Background

Methods

Results

Conclusions

Introduction

The stool syndecan2 methylation test is more robust than blood tests for methylated septin9, CEA, CA19-9 and CA724: a diagnostic test for the early detection of colorectal neoplasms Yixiang Zhan1,2\#, Shuyuan Wang2\#, Zhen Yuan2\#, Xuanzhu Zhao1,3\#, Kemin Ni1,2, Ran Xin2, Xingyu Zhou2, Zhaoce Liu1,2, Xin Yin2, Hangyu Ping2, Yaohong Liu2, Wanting Wang3, Suying Yan3, Qiurong Han3, Xipeng Zhang1,4,5, Qinghuai Zhang1,4,5, Yandi Liu6, Chunze Zhang1,4,5^ 1Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China; 2School of Medicine, Nankai University, Tianjin, China; 3School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China; 4The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China; 5Tianjin Institute of Coloproctology, Tianjin, China; 6Department of Gastroenterology, Tianjin Union Medical Center, Tianjin, China Contributions: (I) Conception and design: C Zhang, Y Liu; (II) Administrative support: Q Zhang, X Zhang; (III) Provision of study materials or patients: Y Zhan, Z Yuan, H Ping, S Yan; (IV) Collection and assembly of data: S Wang, X Zhao, R Xin, Y Liu; (V) Data analysis and interpretation: K Ni, X Zhou, Z Liu, X Yin, W Wang, Q Han; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. \#These authors contributed equally to this work and should be considered as co-first authors. Correspondence to: Yandi Liu. Department of Gastroenterology, Tianjin Union Medical Center, Tianjin, China. Email: [liuyandi66@163.com](liuyandi66@163.com); Chunze Zhang. Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China. Email: [chunze.zhang@nankai.edu.cn](chunze.zhang@nankai.edu.cn). Background: Methylated syndecan2 (mSDC2) in stool samples has been found to be associated with colorectal cancer (CRC) and precancerous lesions. However, the available data are limited, and no previous studies have compared the analysis of mSDC2 with other diagnostic tests. Thus, we aimed to evaluate the clinical performance of a stool mSDC2 test and compare its performance with that of blood-based tests for methylated septin9 (mSEPT9), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 724 (CA724) in detecting colorectal neoplasms. Methods: The gold standard diagnostic technique that was used was colonoscopy combined with a pathological analysis of biopsied tissue. Stool DNA was extracted from 1,002 stool samples (445 from CRCs, 115 from adenomas, and 442 from controls) and then bisulfite-converted, followed by real-time quantitative methylation-specific polymerase chain reaction. Blood mSEPT9 levels were quantified by the Epi proColon 2.0 assay, and serum CEA, CA19-9 and CA724 levels were measured by electrochemiluminescence. The main indexes used during the evaluation were sensitivity, specificity and the area under the receiver operating characteristic curve (AUC) . Results: Stool mSDC2 detected 69.7% of CRCs, which was significantly higher than 53.8% by plasma mSEPT9, 37.2% by CEA, 13.1% by CA19-9 and 17.5% by CA724; for adenoma, the detection rates were 31.3%, 11.1%, 2.3% and 11.9%, respectively. The AUC of mSDC2 in detecting CRC was 0.83, compared to 0.72, 0.75, 0.63 and 0.54 for mSEPT9, CEA, CA19-9 and CA724, respectively. mSDC2 identified patients with stage I–III CRC with a sensitivity of 71.6%, which was significantly higher than that of mSEPT9, CEA, CA19-9 and CA724 (54.2%, 35.5%, 11.9%, and 15.0%, respectively); for stage IV CRC, the sensitivities of mSDC2, mSEPT9, CEA, CA19-9 and CA724 were 75.9%, 82.6%, 79.3%, 36.0% and 56.5%, respectively. SDC2 and CEA had a significantly higher sensitivity for distal CRC than for proximal CRC. Conclusions: The stool SDC2 methylation test had a better performance in detecting nonmetastatic CRC and adenoma than evaluations of mSEPT9, CEA, CA19-9 and CA724 in blood. Our findings could

FAQs

What is the diagnostic test evaluated in this study?

The study evaluates a stool methylated syndecan2 (mSDC2) methylation test for detecting colorectal neoplasms.

How does the study compare mSDC2 with blood-based tests?

mSDC2 performance is compared against blood methylated septin9 (mSEPT9) and blood tumor markers CEA, CA19-9, and CA724, using sensitivity, specificity, and AUC.

What were the main findings for colorectal cancer and adenoma detection?

Stool mSDC2 showed higher detection rates and AUC for CRC than mSEPT9, CEA, CA19-9, and CA724, and it performed better for adenoma as well.

Sep 24, 2026

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