Abstract
Background and study aim: Cholangiocarcinoma (CCA) is a rarely curable cancer and is infrequently diagnosed early. There is a growing interest in evaluating CCA biomarkers in serum and bile. CCA cells express insulin-like growth factor-I (IGF-I) which modulates cell growth and reduces apoptosis. The aim of this study is to evaluate biliary and serum IGF-I as diagnostic biomarkers in patients with extrahepatic cholangio-carcinoma vs. benign biliary obstruction. Patients and Method: We conducted a prospective cross-sectional study on 60 patients with extrahepatic biliary obstruction divided into: CCA group (n=30) and benign obstruction (n=30). All patients had diagnostic and therapeutic ERCP with IGF-I assessment in serum and bile. Results: The CCA group mean age was significantly higher than the benign obstruction group (69.0±4.68 vs. 56.0±6.47years, p˂0.001). The etiologies of benign biliary obstruction were bile duct stones (n=18), benign stricture (n=11) and cholangitis (n=2). The mean biliary IGF-I in CCA patients was significantly higher (19-20 folds) than the benign biliary obstruction group (639.14±86.77 vs. 33.60±8.75, p˂0.001). The mean serum IGF-I in the CAA group was higher than the benign group, however, this was non-significant (223.06±76.53 vs. 198.34±38.74, p=0.192). Biliary IGF-I cutoff of 292.24ng/ml in CCA vs. benign group showed 100% sensitivity and specificity (AUC=1, p=<0.001). While a serum IGF-I cutoff of 236.32ng/mL in CCA vs. benign group showed a sensitivity/ specificity of 50%/80% respectively (AUC=0.614, p=0.081). Conclusion: Biliary but not serum IGF-I was an excellent marker in differentiating extrahepatic CCA from extrahepatic benign biliary obstruction with a 100% sensitivity and specificity. The diagnostic utility of serum IGF-I in biliary malignancies needs further study .
Highlights
Cholangiocarcinoma (CCA), whether extra or intrahepatic, represent1% of all cancers
In this study, we aimed to evaluate biliary and serum insulin-like growth factor-I (IGF-I) as diagnostic biomarkers in patients with extrahepatic cholangiocarcinoma in comparison to benign biliary obstruction lesions
The diagnosis of biliary cancer was based on the results of Endoscopic retrograde cholangiopancreatography (ERCP) criteria in 30(100%) patients and radiologic diagnosis (US and CT/MRCP) in 24 (80%)
Summary
Cholangiocarcinoma (CCA), whether extra or intrahepatic, represent1% of all cancers. CCA is infrequently diagnosed early and clinical signs indicate advanced stage. Used serum markers, such as carbonic anhydrase 19-9 (CA19-9) and carcino-embryonic antigen (CEA), are not specific for CCA and have unsatisfactory diagnostic sensitivity in early stages of cancer. Their combination improves their sensitivity and specificity [3]. Because bile fluid can be aspirated during Endoscopic retrograde cholangiopancreatography (ERCP) aimed to decompress biliary ducts in extrahepatic biliary obstruction, there is a growing interest in evaluating cancer biomarkers in the bile fluid [4, 5]. The aim of this study is to evaluate biliary and serum IGF-I as diagnostic biomarkers in patients with extrahepatic cholangio-carcinoma vs benign biliary obstruction. All patients had diagnostic and therapeutic ERCP with IGF-I assessment in serum and bile
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