Potential biomarkers for early detection of pancreatic ductal adenocarcinoma
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REVIEW ARTICLE
Potential biomarkers for early detection of pancreatic ductal adenocarcinoma D. Kriz1 · D. Ansari1 · R. Andersson1 Received: 16 January 2020 / Accepted: 1 May 2020 © The Author(s) 2020
Abstract Pancreatic cancer has the highest mortality amongst all major organ cancers. Early detection is key to reduce deaths related to pancreatic cancer. However, early detection has been challenged by the lack of non-invasive biomarkers with enough sensitivity and specificity to allow for screening. The gold standard is still carbohydrate antigen (CA 19-9), against which all new biomarkers must be evaluated. In this paper, we describe recent progress in the development of new pancreatic cancer biomarkers, focusing on proteins, metabolites, and genetic and epigenetic biomarkers. Although several promising biomarkers have been identified, they are all derived from retrospective studies and additional prospective studies are needed to confirm their clinical validity. Keywords Pancreatic cancer · Early detection · Biomarkers · Sensitivity · Specificity
Introduction Pancreatic ductal adenocarcinoma (PDAC), commonly known as pancreatic cancer, has the highest mortality rate of all major cancers. Despite many years of experimental research and clinical trials, the 5-year survival rate for pancreatic cancer is still less than 5% when all stages are considered [1]. The major reason for the poor survival is due to late detection. By the time the cancer is detected, it is usually locally advanced or metastatic. It is still unknown whether pancreatic cancer is a stepwise process with metastasis occurring late [2] or whether metastasis occurs early in neoplastic transformation [3]. Nevertheless, most agree that detecting pancreatic cancer in resectable stages is still the first step in any early detection strategy [4]. Carbohydrate antigen (CA) 19-9 is the only clinically used serum biomarker for pancreatic cancer. It is elevated in approximately 80% of all pancreatic cancer patients [5]. However, CA 19-9 has a low specificity and sensitivity in asymptomatic patients, and thus can merely be used for disease monitoring rather than early detection. Therefore, new biomarkers are needed. * R. Andersson [email protected] 1
Department of Surgery, Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
A multitude of biomarkers have been proposed for early detection of pancreatic cancer derived from blood, tissue, pancreatic juice, saliva and urine. They can be classified into proteins, metabolites, and genetic and epigenetic biomarkers, including panels thereof. In this review, we provide a comprehensive summary of new non-invasive biomarkers for pancreatic cancer published during the last 5 years and their performance and clinical utility concerning early detection.
Blood‑based biomarkers Blood is likely the most accessible biofluid for non-invasive, early detection. Many promising blood-based biomarkers have been identified for early-stage pancreatic cancer (Tables 1, 2, 3, 4).
CA 19‑9 T
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