Abstract
The serum macrophage inhibitory cytokine-1 (MIC-1) levels are elevated in some inflammatory conditions and cancers. We thus compared the levels of biliary and serum MIC-1 and conventional tumour markers between 23 biliary tract cancer (BTC) patients (malignant group) and 29 benign biliary disease patients (benign group) and found that all markers were significantly elevated in the malignant group. The levels of two markers were higher in early BTC (Stage I/II, n = 15) than in the benign group: biliary MIC-1 [12 (0–2153) vs. 678 (0–4429) pg/ml, P < 0.01] and serum CA19–9 [13 (2–15,682) vs. 45.1 (2–10,478) U/ml, P = 0.02]. A receiver operating characteristic curve analysis revealed that the area under the curve for biliary MIC-1 was greater than that for serum CA19-9 (0.77 vs. 0.73). The cut-off value for biliary MIC-1 in diagnosing early BTC was 581.6 pg/ml, and this value yielded a sensitivity, specificity and accuracy of 71.4%, 82.8%, and 79.1%, respectively. The sensitivity of biliary MIC-1 for diagnosing early BTC was superior to that of biliary cytology (71.4% vs. 8.33%, P < 0.01), and the combination of serum MIC-1 with CA19-9 (cut-off value = 4021.2 pg/ml, 42.4 U/ml) was useful for screening BTC (sensitivity = 82.6%, specificity = 72.4%). In conclusion, biliary MIC-1 can effectively diagnose early BTC.
Highlights
The diagnosis of biliary tract cancer is challenging, and current methods include the evaluation of tumour markers (CEA or CA19-9), biliary fluid cytology, brush cytology, and biopsy
We investigated the efficacy of biliary and serum macrophage inhibitory cytokine-1 (MIC-1) for the diagnosis of malignant biliary diseases and found that biliary MIC-1 was significantly elevated in early biliary tract cancer patients
Biliary MIC-1 was significantly elevated in the biliary tract cancer group compared with the benign group
Summary
The diagnosis of biliary tract cancer is challenging, and current methods include the evaluation of tumour markers (CEA or CA19-9), biliary fluid cytology, brush cytology, and biopsy. CA19-9 has been reported to be elevated in up to 85% of patients with cholangiocarcinoma, CA19-9 elevation can be observed in obstructive jaundice without malignancy. CEA elevation is not observed in obstructive jaundice but occurs in 30% of patients with cholangiocarcinoma[16]. The efficacy of serum macrophage inhibitory cytokine-1 (MIC-1), which is a type of transforming growth factor-β, for the diagnosis of pancreatic cancer was recently reported[17,18,19]. Serum MIC-1 has been found to be upregulated by several cancers, inflammation, and cytotoxic drugs[19,20,21] and in pancreatic cancer and cholangiocarcinoma patients[17]. The relationship between pancreatic cancer and serum MIC-1 has been explored, few studies have examined the relationship between biliary cancer and MIC-1
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