Urine test can detect early stage pancreatic cancer

Abstract

Tomasz Radon (Barts Cancer Institute, London, UK) and colleagues have devised a non-invasive three-protein bio marker panel for the detection of early stage pancreatic cancer in urine samples. Timely detection of pancreatic ductal adenocarcinoma (PDAC) is important because an early diagnosis can substantially improve 5-year survival—nearly 70% survival has been reported in patients with stage I PDAC tumours (when they are confi ned to the pancreas with a size of less than 2 cm). Using mass spectrometry-based proteonomics analysis (GeLC/MS/ MS), the researchers assayed 18 urine samples from healthy controls and patients with chronic pancreatitis or PDAC and selected three candidate biomarkers—LYVE1, REG1A, and TFF1. The biomarkers were validated in urine samples from a multicentre cohort of 371 patients; the researchers compared samples from patients with PDAC (n=192) with those from healthy individuals (n=87) and those with chronic pancreatitis (n=92). The biomarker panel had good diagnostic performance measured by ROC curve analysis in the training (AUC 0·89, 95% CI 0·85–0·94) and validation (AUC 0·92, 95% CI 0·86–0·98) sets. The biomarkers could also identify early PDAC (stage I–II) when compared with healthy controls in the training (AUC 0·90, 95% CI 0·84–0·96) and validation (AUC 0·93, 95% CI 0·84–1·00) sets. Together, REG1A, TFF1, and LYVE1 create a urinary biomarker panel that can accurately detect stage I–II PDAC. “The importance of the study is the possibility of having a completely non-invasive test for early detection of pancreatic cancer using urine samples”, said Tatjana CrnogoracJurcevic, an author on the study (Barts Cancer Institute, London, UK). “Currently such patients are diagnosed with disease that has already spread locally or with metastases, and are not amenable to surgery; their survival is typically 3–6 months”, she said. “If diagnosed at an early stage, the patient’s chances of survival can be greatly increased”, she added. However, according to Jose Trevino (University of Florida, FL, USA), although this is an important study, “it still does not address which patients specifi cally should undergo testing for early pancreatic cancer”. He added, “unfortunately, even when patients are diagnosed in the early stages of pancreatic cancer and off ered surgical intervention, the 5-year survival rate in US tertiary care centres (where multidisciplinary care specialising in pancreatic cancer is provided) still hovers around 20–30%.”