Diagnostic performance of serum metabolites biomarker associated with colorectal adenoma: a systematic review

Evidence on serum biomarkers as a non-invasive tool to detect colorectal adenoma (CRA) in the general population is quite promising. However, the sensitivity and specificity of these serum biomarkers in detecting disease are still questionable. This study aimed to systematically review the evidence on the diagnostic performance of serum biomarkers associated with CRA. Database searches on PubMed, Scopus, and WoS from January 2014 to December 2023 using PRISMA guidelines resulted in 4,380 citations, nine of which met inclusion criteria. The quality of these studies was assessed using the QUADOMICS tool. These studies reported on 77 individual/panel biomarkers which were further analysed to find associated altered pathways using MetaboAnlyst 5.0. Diagnostic accuracy analysis of these biomarkers was conducted by constructing a receiver operating characteristic (ROC) curve using their reported sensitivity and specificity. This review identified six potential serum metabolite biomarkers with 0.7vs. normal, while adenosine, pentothenate, and linoleic acid are highly remarkable for CRA vs. CRC. The five most affected pathways for CRA vs. normal are glycoxylate and dicarboxylate metabolism; alanine, aspartate, and glutamate metabolism; aminoacyl-tRNA biosynthesis; D-glutamine and D-glutamate metabolism; and nitrogen metabolism. Meanwhile, pyruvate metabolism, glycolysis/gluconeogenesis, glycerolipid metabolism, citrate/TCA cycle, and alanine, aspartate, and glutamate metabolism were found to be altered in CRA vs. CRC. However, the association of suggested serum metabolites and altered pathways is still unknown. Despite promising emerging evidence, further validation studies in a diverse population with standardized methodology are needed to validate the findings.