image: The comparison of the ROC curves of the APCS-SDC2 score and APCS score in the diagnosis of adenomas (a: development set, b: validation set) and advanced adenomas (c: development set, d: validation set). The APCS-SDC2 scoring system was developed using 632 samples selected randomly. Ordered logistic regression and bootstrap optimism correction were applied to assess the effects of predictor variables and assign corresponding scores. The validation cohort, including 316 samples, was used to validate the model’s performance. The shaded area represents the 95% confidence interval. APCS, Asia-Pacific Colorectal Screening Scoring; AUC, area under the curve; CI, confidence interval; ROC, receiver operating characteristic curve; SDC2, syndecan-2.
Credit: Bin Lyu
Background and objectives
Accumulating evidence indicates that fecal syndecan-2 (SDC2) methylation is a promising biomarker for early detection of colorectal cancer. This study aimed to investigate the diagnostic efficacy of fecal SDC2 methylation testing for adenomas and evaluate the risk stratification efficacy of the Asia-Pacific Colorectal Screening Scoring (APCS) combined with SDC2 methylation status.
Methods
This was a prospective, multicenter diagnostic study. Adult participants with no history of colonoscopy within the past three years were enrolled. Demographic data were collected, and APCS scores were evaluated. All participants underwent fecal SDC2 methylation testing and colonoscopy. Colonoscopy outcomes and pathological results of any polyps served as reference standards. The fecal SDC2 methylation test and reference standard assessments were conducted in a blinded manner. The APCS-SDC2 scoring system was developed by integrating fecal SDC2 methylation results with APCS scores, and its efficacy was assessed.
Results
In total, 985 participants were enrolled, among whom 62 (6.3%) tested positive for fecal SDC2 methylation. The sensitivity and specificity of fecal SDC2 methylation in detecting advanced adenomas were 31.3% (95% confidence interval (CI): 21.6–42.7%) and 96.1% (95% CI: 94.6–97.2%), respectively. The APCS-SDC2 scoring system demonstrated superior discriminatory performance for advanced adenomas (area under the curve: 0.7032; 95% CI: 0.5869–0.8195). For advanced adenoma screening, the specificity of the APCS-SDC2 score was higher than that of the APCS score (86.7% vs. 66.7%; P < 0.001).
Conclusions
Among individuals with positive fecal SDC2 methylation test results, the detection rates of advanced adenomas were significantly elevated, and colonoscopy should be prioritized. The APCS-SDC2 scoring system, which integrates fecal SDC2 methylation testing, demonstrated superior risk stratification performance for advanced adenomas compared with the APCS scoring system, along with higher specificity.
Full text
https://www.xiahepublishing.com/2835-3315/CSP-2025-00025
The study was recently published in the Cancer Screening and Prevention.
Cancer Screening and Prevention (CSP) publishes high-quality research and review articles related to cancer screening and prevention. It aims to provide a platform for studies that develop innovative and creative strategies and precise models for screening, early detection, and prevention of various cancers. Studies on the integration of precision cancer prevention multiomics where cancer screening, early detection and prevention regimens can precisely reflect the risk of cancer from dissected genomic and environmental parameters are particularly welcome.
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Journal
Cancer Screening and Prevention
Article Title
Performance of the APCS-SDC2 Score Based on a Fecal SDC2 Methylation Assay for the Detection of Colorectal Polyps: A Multicenter Diagnostic Study
Article Publication Date
19-Dec-2025