Matsunaga Taketo, Ohtsuka Takao, Asano Koichi, Kimura Hideyo, Ohuchida Kenoki, Kitada Hidehisa, Ideno Noboru, Mori Yasuhisa, Tokunaga Shoji, Oda Yoshinao, Guha Sushovan, Raimondo Massimo, Nakamura Masafumi, Tanaka Masao
From the Departments of *Surgery and Oncology and †Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University; ‡Medical Information Center, Kyushu University Hospital; and §Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; ∥Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The University of Texas Medical School at Houston, TX; and ¶Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL.
Pancreas. 2017 Nov/Dec;46(10):1288-1295. doi: 10.1097/MPA.0000000000000940.
The development of an effective screening method for pancreatic ductal adenocarcinoma (PDAC) is of paramount importance. This study assessed the diagnostic utility in pancreatic diseases of duodenal markers during upper gastrointestinal endoscopy (GIE) or endoscopic ultrasonography.
This study prospectively enrolled 299 consecutive participants, including 94 patients with PDACs, 144 patients with other pancreatic diseases, and 61 normal individuals as control subjects. All subjects underwent upper GIE or endoscopic ultrasonography either at Kyushu University Hospital (Fukuoka, Japan) or the Mayo Clinic (Jacksonville, Fla) from October 2011 to July 2014. Duodenal fluid (DF) was collected without secretin stimulation and of carcinoembryonic antigen and S100 calcium-binding protein P (S100P) concentrations were measured.
Concentrations of S100P in DF were significantly higher in patients with PDAC and chronic pancreatitis than in control subjects (P < 0.01). A logistic regression model that included age found that the sensitivity and specificity of S100P concentration in diagnosing stages 0/IA/IB/IIA PDAC were 85% and 77%, respectively, with an area under the receiver operating characteristic curve of 0.82. Carcinoembryonic antigen concentrations in DF of patients with pancreatic disease did not differ significantly from control subjects.
Analysis of S100P concentration in DF, in combination with routine screening upper GIE, may facilitate the detection of PDAC.
开发一种有效的胰腺导管腺癌（PDAC）筛查方法至关重要。本研究评估了上消化道内镜检查（GIE）或内镜超声检查期间十二指肠标志物在胰腺疾病中的诊断效用。
本研究前瞻性纳入了299名连续参与者，包括94例PDAC患者、144例其他胰腺疾病患者和61名正常个体作为对照。2011年10月至2014年7月期间，所有受试者均在九州大学医院（日本福冈）或梅奥诊所（佛罗里达州杰克逊维尔）接受了上消化道GIE或内镜超声检查。在无促胰液素刺激的情况下收集十二指肠液（DF），并测量癌胚抗原和S100钙结合蛋白P（S100P）的浓度。
PDAC和慢性胰腺炎患者DF中S100P的浓度显著高于对照受试者（P<0.01）。包含年龄的逻辑回归模型显示，S100P浓度诊断0/IA/IB/IIA期PDAC的敏感性和特异性分别为85%和77%，受试者操作特征曲线下面积为0.82。胰腺疾病患者DF中的癌胚抗原浓度与对照受试者无显著差异。
DF中S100P浓度分析结合常规上消化道GIE筛查，可能有助于PDAC的检测。
