Abstract
Objective: The study aimed to evaluate the utility of N1,N12-diacetylspermine (DiAcSpm) as a noninvasive urinary biomarker for early screening of various gastrointestinal cancers, including gastric, colorectal, and pancreatic cancers. Given the high costs and logistical barriers to endoscopic screening, a targeted approach focusing on high-risk populations is necessary to optimize resource allocation and enhance early cancer detection.
Subjects and Methods: This study analyzed urinary DiAcSpm levels in 78 healthy adults and 125 cancer patients, with samples obtained from biobanks and stored at -80°C. DiAcSpm concentration was measured using ELISA and normalized by urinary creatinine (Cre) levels. Cancer detection performance was assessed using the receiver operating characteristic (ROC) curve, and sensitivity and specificity were calculated based on the Youden index.
Results: Urinary DiAcSpm/Cre levels were significantly higher in the cancer group (median 398.1 nM/g Cre) than in the non-cancer group (median 158.1 nM/g Cre, p<0.001), with an AUC of 0.82 indicating strong diagnostic potential. Sensitivity and specificity were 0.78 and 0.82, respectively. DiAcSpm/Cre levels increased with the cancer stage. They showed varying detection performance by cancer type, with high areas under the curve (AUC) for colorectal and gastric cancers at early stages but lower for early-stage pancreatic cancer.
Conclusions: Urinary DiAcSpm is a promising biomarker for gastrointestinal cancers, potentially improving early detection in noninvasive screening. Its diagnostic efficiency varies by cancer type and stage, highlighting the need for further refinement to maximize clinical application.
