Abstract
Liquid biopsy (LB) is a non-invasive approach representing a promising tool for new precision medicine strategies for cancer treatment. However, a comprehensive analysis of its reliability for pancreatic cancer (PC) is lacking. To this aim, we performed the first meta-analysis on this topic. We calculated the pooled sensitivity, specificity, positive (LR+) and negative (LR−) likelihood ratio, and diagnostic odds ratio (DOR). A summary receiver operating characteristic curve (SROC) and area under curve (AUC) were used to evaluate the overall accuracy. We finally assessed the concordance rate of all mutations detected by multi-genes panels. Fourteen eligible studies involving 369 patients were included. The overall pooled sensitivity and specificity were 0.70 and 0.86, respectively. The LR+ was 3.85, the LR- was 0.34 and DOR was 15.84. The SROC curve with an AUC of 0.88 indicated a relatively high accuracy of LB for molecular characterization of PC. The concordance rate of all mutations detected by multi-genes panels was 31.9%. LB can serve as surrogate for tissue in the molecular profiling of PC, because of its relatively high sensitivity, specificity and accuracy. It represents a unique opportunity to be further explored towards its introduction in clinical practice and for developing new precision medicine approaches against PC.
Highlights
Pancreatic cancer is a lethal malignancy with an increasing incidence, and it is projected to become the second most common cause of cancer-related death in the world at the end of the decade [1,2,3].The most common type of pancreatic cancer is represented by ductal adenocarcinoma (PDAC), which is responsible for more than 95% of deaths from pancreatic cancer [3,4].At the time of diagnosis, the vast majority of patients with PDAC present with locally advanced or metastatic disease and are not amenable to surgical resection with a curative purpose [3]
Our results showed that LR+ was 3.85, LR- was 0.34 and diagnostic odds ratio (DOR) was 15.84 (Figure 1A)
Regarding the slightly higher specificity, we have found for KRAS compared with all genes, it is important to acknowledge that the KRAS mutation is not highly specific for PDAC, even if matched with histology [49]
Summary
The most common type of pancreatic cancer is represented by ductal adenocarcinoma (PDAC), which is responsible for more than 95% of deaths from pancreatic cancer [3,4]. At the time of diagnosis, the vast majority of patients with PDAC present with locally advanced or metastatic disease and are not amenable to surgical resection with a curative purpose [3]. For such patients, the priority is to receive an undebatable diagnosis of cancer including useful information for addressing all potential therapeutic approaches.
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