胰腺癌的早期检测:生物标志物在胰液样本中的作用
Early Detection of Pancreatic Cancer: Role of Biomarkers in Pancreatic Fluid Samples.
作者信息
Ideno Noboru, Mori Yasuhisa, Nakamura Masafumi, Ohtsuka Takao
机构信息
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, Kagoshima 890-8520, Japan.
出版信息
Diagnostics (Basel). 2020 Dec 6;10(12):1056. doi: 10.3390/diagnostics10121056.
Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related deaths worldwide. Most patients with PDAC present with symptomatic, surgically unresectable disease. Therefore, the establishment of strategies for the early detection is urgently needed. Molecular biomarkers might be useful in various phases of a strategy to identify high-risk individuals in the general population and to detect high-risk lesions during intense surveillance programs combined with imaging modalities. However, the low sensitivity and specificity of biomarkers currently available for PDAC, such as carbohydrate 19-9 (CA19-9), contribute to the late diagnosis of this deadly disease. Although almost all classes of biomarker assays have been studied, most of them are used in the context of symptomatic diseases. Compared to other body fluids, pancreatic juice and duodenal fluid are better sources of DNA, RNA, proteins, and exosomes derived from neoplastic cells and have the potential to increase the sensitivity/specificity of these biomarkers. The number of studies using duodenal fluid with or without secretin stimulation for DNA/protein marker tests have been increasing because of the less-invasiveness in comparison to pancreatic juice collection by endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Genomic analyses have been very well-studied, and based on PDAC progression model, mutations detected in pancreatic juice/duodenal fluid seem to indicate the presence of microscopic precursors and high-grade dysplasia/invasive cancer. In addition to known proteins overexpressed both in precursors and PDACs, such as CEA and S100P, comprehensive proteomic analysis of pancreatic juice from patients with PDAC identified many proteins which were not previously described. A novel technique to isolate exosomes from pancreatic juice was recently invented and identification of exosomal microRNA's 21 and 155 could be biomarkers for diagnosis of PDAC. Since many studies have explored biomarkers in fluid samples containing pancreatic juice and reported excellent diagnostic accuracy, we need to discuss how these biomarker assays can be validated and utilized in the strategy of early detection of PDAC.
胰腺导管腺癌(PDAC)是全球癌症相关死亡的第四大主要原因。大多数PDAC患者表现为有症状的、手术无法切除的疾病。因此,迫切需要建立早期检测策略。分子生物标志物可能在策略的各个阶段都有用,以识别普通人群中的高危个体,并在结合成像方式的强化监测计划中检测高危病变。然而,目前可用于PDAC的生物标志物,如糖类抗原19-9(CA19-9),其低敏感性和特异性导致了这种致命疾病的晚期诊断。尽管几乎所有类型的生物标志物检测都已被研究,但其中大多数是在有症状疾病的背景下使用的。与其他体液相比,胰液和十二指肠液是来自肿瘤细胞的DNA、RNA、蛋白质和外泌体的更好来源,并且有可能提高这些生物标志物的敏感性/特异性。由于与通过内镜逆行胰胆管造影(ERCP)和内镜超声引导下细针穿刺活检(EUS-FNA)采集胰液相比,其侵入性较小,使用十二指肠液(无论是否有促胰液素刺激)进行DNA/蛋白质标志物检测的研究数量一直在增加。基因组分析已经得到了很好的研究,基于PDAC进展模型,在胰液/十二指肠液中检测到的突变似乎表明存在微小前驱病变和高级别发育异常/浸润性癌。除了在前驱病变和PDAC中均过表达的已知蛋白质,如癌胚抗原(CEA)和S100P,对PDAC患者胰液的综合蛋白质组分析还鉴定出许多以前未描述过的蛋白质。最近发明了一种从胰液中分离外泌体的新技术,外泌体微小RNA 21和155的鉴定可能成为PDAC诊断的生物标志物。由于许多研究已经在含有胰液的液体样本中探索了生物标志物,并报告了出色的诊断准确性,我们需要讨论如何在PDAC早期检测策略中验证和利用这些生物标志物检测。