Abstract
Simple SummaryPancreatic ductal adenocarcinoma (PDAC), which represents approximately 90% of all pancreatic cancers, is an extremely aggressive and lethal disease. It is considered a silent killer due to a largely asymptomatic course and late clinical presentation. Earlier detection of the disease would likely have a great impact on changing the currently poor survival figures for this malignancy. In this comprehensive review, we assessed over 4000 reports on non-invasive PDAC biomarkers in the last decade. Applying the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool, we selected and reviewed in more detail 49 relevant studies reporting on the most promising candidate biomarkers. In addition, we also highlight the present challenges and complexities of translating novel biomarkers into clinical use.Pancreatic ductal adenocarcinoma (PDAC) carries a deadly diagnosis, due in large part to delayed presentation when the disease is already at an advanced stage. CA19-9 is currently the most commonly utilized biomarker for PDAC; however, it lacks the necessary accuracy to detect precursor lesions or stage I PDAC. Novel biomarkers that could detect this malignancy with improved sensitivity (SN) and specificity (SP) would likely result in more curative resections and more effective therapeutic interventions, changing thus the present dismal survival figures. The aim of this study was to systematically and comprehensively review the scientific literature on non-invasive biomarkers in biofluids such as blood, urine and saliva that were attempting earlier PDAC detection. The search performed covered a period of 10 years (January 2010—August 2020). Data were extracted using keywords search in the three databases: MEDLINE, Web of Science and Embase. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was applied for study selection based on establishing the risk of bias and applicability concerns in Patient Selection, Index test (biomarker assay) and Reference Standard (standard-of-care diagnostic test). Out of initially over 4000 published reports, 49 relevant studies were selected and reviewed in more detail. In addition, we discuss the present challenges and complexities in the path of translating the discovered biomarkers into the clinical setting. Our systematic review highlighted several promising biomarkers that could, either alone or in combination with CA19-9, potentially improve earlier detection of PDAC. Overall, reviewed biomarker studies should aim to improve methodological and reporting quality, and novel candidate biomarkers should be investigated further in order to demonstrate their clinical usefulness. However, challenges and complexities in the path of translating the discovered biomarkers from the research laboratory to the clinical setting remain and would have to be addressed before a more realistic breakthrough in earlier detection of PDAC is achieved.
Highlights
Pancreatic ductal adenocarcinoma (PDAC), which represents approximately 90%of all pancreatic cancers, is an extremely aggressive disease and one of the most lethal cancers
If PDAC is detected when still a localized disease, the 5-year survival is around 32% [11], but it can approach 70% following resection of incidentally diagnosed stage I tumors [12–14]
It is estimated that it takes at least 10 years between initiating mutation and the birth of parental founder [15]; combined with an increased PDAC incidence with age [5], resectable PDAC has likely already been growing for a number of years
Summary
Pancreatic ductal adenocarcinoma (PDAC), which represents approximately 90%of all pancreatic cancers, is an extremely aggressive disease and one of the most lethal cancers. Its incidence almost equals its mortality, and it has a 5-year survival of only around 9% [1,2]. It caused 7800 deaths in the United Kingdom (UK) in 2018 alone, and, according to GLOBOCAN, there were 458,918 new cases of pancreatic cancer and 432,242 pancreatic cancer-related deaths worldwide in the same year [3]. If PDAC is detected when still a localized disease, the 5-year survival is around 32% [11], but it can approach 70% following resection of incidentally diagnosed stage I tumors [12–14]. It is estimated that it takes at least 10 years between initiating mutation and the birth of parental founder [15]; combined with an increased PDAC incidence with age [5], resectable PDAC has likely already been growing for a number of years. We further on use the term “earlier” rather than “early” stage
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
