Abstract
PurposeDistal cholangiocarcinoma and pancreatic ductal adenocarcinoma are malignancies with poor prognoses that can be difficult to distinguish preoperatively. Thrombospondin-2 has been proposed as a novel diagnostic biomarker for early pancreatic ductal adenocarcinoma. The aim of the present study was to evaluate thrombospondin-2 as a diagnostic and prognostic biomarker in combination with current biomarker CA 19-9 for distal cholangiocarcinoma and pancreatic ductal adenocarcinoma.MethodsThrombospondin-2 was measured in prospectively collected serum samples from patients who underwent surgery with a histopathological diagnosis of distal cholangiocarcinoma (N = 51), pancreatic ductal adenocarcinoma (N = 52) and benign pancreatic diseases (N = 27) as well as healthy blood donors (N = 52) using an enzyme-linked immunosorbent assay.ResultsThrombospondin-2 levels (ng/ml) were similar in distal cholangiocarcinoma 55 (41–77) and pancreatic ductal adenocarcinoma 48 (35–80) (P = 0.221). Thrombospondin-2 + CA 19-9 had an area under the curve of 0.92 (95% CI 0.88–0.97) in differentiating distal cholangiocarcinoma and pancreatic ductal adenocarcinoma from healthy donors which was superior to CA 19-9 alone (P < 0.001). The diagnostic value of adding thrombospondin-2 to CA 19-9 was larger in early disease stages. Thrombospondin-2 did not provide additional value to CA 19-9 in differentiating the benign disease group; however, heterogeneity was notable in the benign cohort. Three of five patients with autoimmune pancreatitis patients had greatly elevated thrombospondin-2 levels. Thrombospondin-2 levels had no correlation with prognoses.ConclusionsSerum thrombospondin-2 in combination with CA 19-9 has potential as a biomarker for distal cholangiocarcinoma and pancreatic cancer.
Highlights
Cholangiocarcinoma (CCA) constitutes diverse cancers originating from the biliary tree, accounting for approximately 3% of gastrointestinal cancers [1]
The purpose of the present study was to evaluate the expression of serum THBS2 in Distal cholangiocarcinoma (dCCA) and assess its performance as a diagnostic biomarker for dCCA compared to cohorts with pancreatic ductal adenocarcinoma (PDAC), benign diseases (BDs) and healthy donors (HDs)
carbohydrate antigen 19-9 (CA 19-9) was higher in PDAC than in BDs (P < 0.001) and HDs (P < 0.001)
Summary
Cholangiocarcinoma (CCA) constitutes diverse cancers originating from the biliary tree, accounting for approximately 3% of gastrointestinal cancers [1]. Many patients currently present with advanced disease and are unamenable to curative resection [2]. Distal cholangiocarcinoma (dCCA) is a subgroup that arises in the region of the common bile duct that traverses the pancreatic head. DCCA is located between the cystic duct insertion and the Ampulla of Vater [3]. There is currently only one biomarker in use for the diagnosis of both CCA and PDAC, namely serum carbohydrate antigen 19-9 (CA 19-9). Especially in early stages, means that the primary use of CA 19-9 is in monitoring disease progression [8]
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