Abstract
Background: The rising incidence and mortality of colorectal Cancer (CRC) around the world, makes it as a major public health concern. Human growth differentiation factor 15 (GDF-15) is elevated in many cancer patients and is associated with tumor pathogenesis and progression. The aim of the present study was to find the best diagnosis of metastatic CRC and to compare serum levels of GDF-15 in patients with non-metastatic CRC and those with metastatic CRC.
Patients and methods: The study included 60 subjects and was carried out at Internal Medicine Department, Faculty of Medicine, Zagazig University. All subjects of this study were subjected to the following full history taking, clinical examination and laboratory investigations.
Results: Cirrhotic liver (10%) but others had normal liver by imaging (56.7%), there were 12 patient had enlarged spleen (40%) and 11 patients had IPPF (36.7%). There were four patients with lymph node metastasis (13.3%). Two patients had peritoneal metastasis (6.7%). There were statistically significant differences between colorectal carcinoma and metastatic colorectal carcinoma groups regarding imaging of the liver, splenomegaly. There were 14 patients with resected primary tumor (46.7%).Twenty five patients presented by malignant features in colonoscopy (83.3%) and 23 patients had polyps (76.7%).There were no statistically significant differences between colorectal carcinomaand metastatic colorectal carcinoma groups regarding all colonoscopy findings. Twenty eight patients had adenocarcinoma type (93.3 %) and only two had mucinous type (6.7%). There was statistically significant difference between colorectal carcinoma group and metastatic colorectal carcinoma group regarding staging as P< 0.001. There were no statistically significant differences the two groups regarding other histopathological examination. on comparing GDF-15 with other parameters in non-metastatic colorectal carcinoma group there were direct significant correlation between GDF-15 and CEA, CA 19-9 and ESR with P= 0.007, 0.022 and0.033 respectively. In metastatic colorectal carcinoma group, on comparing GDF-15 with other parameters there were direct significant correlation between GDF-15 and(total bilirubin and CEA) with P=0.011 and 0.048 respectively.
Conclusion: High Growth differentiation factor 15 (GDF-15) can act as a valuable independent biomarker for screening CRC in comparison with CEA and other tumor biomarkers. Furthermore, an elevated GDF-15 in a cutoff value can identify CRC metastasis especially to the liver metastasis.

Key words: GDF-15; Colorectal Cancer; CEA

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