Deskur Anna, Sałata Daria, Budkowska Marta, Dołęgowska Barbara, Starzyńska Teresa, Błogowski Wojciech
Department of Gastroenterology, Pomeranian Medical University in Szczecin Poland.
Department of Medical Analytics, Pomeranian Medical University in Szczecin Poland.
Am J Transl Res. 2014 Nov 22;6(6):768-76. eCollection 2014.
Recent experimental studies have suggested that various coagulation-related molecules may be important players in the development and progression of pancreatic cancer. However, these findings have not yet been verified in a clinical setting.
In this study, we comprehensively examined the levels of multiple hemostatic substances, including prothrombin, antithrombin, plasminogen, thrombin-anti-thrombin (TAT) and plasmin-anti-plasmin (PAP) complexes, as well as, soluble CD40 (sCD40) in patients diagnosed with pancreatic cancer (n = 37) or other tumors (neuroendocrine neoplasms - NEN [n = 7] or solid pseudopapillary tumors-SPT [n = 3]), and healthy individuals (n = 31).
We found significantly higher anti-thrombin, PAP and sCD40 levels in patients with pancreatic cancer compared to healthy controls and patients diagnosed with other types of pancreatic tumors (for all, at least p < 0.05). Cancer patients had lower plasminogen concentrations than individuals from the other analyzed groups (for both, p < 0.05). None of the examined coagulation-related parameters was significantly associated with neither systemic sCD40 concentrations nor clinical staging of malignancy. Levels of analyzed molecules were comparable between pancreatic cancer patients presenting with early and advanced disease. Moreover, our study identified a potential diagnostic value of prothrombin/TAT and anti-thrombin/TAT coefficients in detection of pancreatic cancer in humans. However, both of these were inferior to currently used marker-CA19.9.
Subclinical hemostatic alterations (mainly in plasmin-related molecules) i) appear as soon as during the earliest stages of the pancreatic adenocarcinoma development in humans, ii) do not seem to alter within progression of the disease nor are associated with clinical staging, iii) are not observed in patients with other types of pancreatic tumors, as well as, iv) do not seem to be associated with elevated sCD40 concentrations in pancreatic cancer patients. Moreover, examined thrombin- and plasmin-related substances do not appear to possess a sufficient diagnostic value to serve as makers of pancreatic adenocarcinoma in humans.
最近的实验研究表明，各种凝血相关分子可能在胰腺癌的发生和发展中起重要作用。然而，这些发现尚未在临床环境中得到验证。
在本研究中，我们全面检测了37例胰腺癌患者、7例神经内分泌肿瘤（NEN）患者、3例实性假乳头状肿瘤（SPT）患者以及31例健康个体中多种止血物质的水平，包括凝血酶原、抗凝血酶、纤溶酶原、凝血酶 - 抗凝血酶（TAT）复合物和纤溶酶 - 抗纤溶酶（PAP）复合物，以及可溶性CD40（sCD40）。
我们发现，与健康对照组和其他类型胰腺肿瘤患者相比，胰腺癌患者的抗凝血酶、PAP和sCD40水平显著更高（所有比较，p均<0.05）。癌症患者的纤溶酶原浓度低于其他分析组的个体（两者比较，p<0.05）。所检测的凝血相关参数均与全身sCD40浓度或恶性肿瘤的临床分期无显著相关性。早期和晚期胰腺癌患者的分析分子水平相当。此外，我们的研究确定了凝血酶原/TAT和抗凝血酶/TAT系数在人类胰腺癌检测中的潜在诊断价值。然而，这两者均不如目前使用的标志物CA19.9。
亚临床止血改变（主要涉及纤溶相关分子）：i）在人类胰腺腺癌发展的最早阶段即出现；ii）在疾病进展过程中似乎未发生改变，也与临床分期无关；iii）在其他类型胰腺肿瘤患者中未观察到；iv）似乎与胰腺癌患者sCD40浓度升高无关。此外，所检测的凝血酶和纤溶相关物质似乎没有足够的诊断价值作为人类胰腺腺癌的标志物。
