Accuracy of Faecal Matrix-Metalloproteinase-9 (MMP-9) for Colorectal Cancer Detection in Makassar, Indonesia.

BACKGROUND: Colorectal cancer (CRC) is one of the most frequent malignancies. Insufficient comprehensive screening by health authorities raises colorectal cancer risk in developing countries. While colonoscopy is the gold standard for CRC diagnosis, it has limitations. Faecal immunochemical test (FIT) and guaiac faecal occult blood test (gFOBT) are famous for colorectal cancer screening tests. FIT is more sensitive and specific than gFOBT. However, both FIT and gFOBT have limited accuracy in diagnosing advanced adenoma and proximal colon cancer. Matrix-metalloproteinase-9 (MMP-9) remodels the extracellular matrix and is associated with CRC progression. Its levels can be detected in faecal samples. Studies specifically evaluating the accuracy of faecal MMP-9 as a diagnostic test are limited. Therefore, this study aims to evaluate the accuracy of faecal MMP-9 for detecting colorectal cancer in our centre. METHODS: Ninety patients provided faecal samples for MMP-9 analysis. Faecal MMP-9 levels were measured by ELISA. Diagnostic accuracy was evaluated using the diagnostic test method. RESULT: Patients were divided into four groups: control: 10; hyperplastic and adenoma polyp: 9; colitis and proctitis: 37; and colorectal carcinoma: 34. Faecal MMP-9 levels significantly increased in colorectal carcinoma compared to the other group (P<0.001). ROC analysis indicated that the accuracy of faecal MMP-9 in differentiating CRC patients against controls was good, with the area under curve (AUC) 0.85 (sensitivity 82.35% and specificity 80%). The accuracy of faecal MMP-9 for detecting proximal colon cancer was excellent, with an AUC of 0.96 (sensitivity 80% and specificity 80%). The AUC for adenoma detection was 0.83, with a sensitivity of 77.78% and specificity of 80%. CONCLUSION: Faecal MMP-9 demonstrated significant accuracy in differentiating colorectal cancer from normal subjects, exhibiting satisfactory sensitivity and specificity. Compared to FIT, Faecal MMP-9 demonstrated superior detection of proximal colon cancer and adenoma.