Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Hepato-Pancreatico-Biliary Unit, Department of General Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
PLoS One. 2022 Jan 12;17(1):e0262439. doi: 10.1371/journal.pone.0262439. eCollection 2022.
BACKGROUND/OBJECTIVES: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy associated with high metastatic risk. Prognosis remains poor even after resection. Previously our group identified biomarkers that improved diagnostic accuracy in PDAC beyond the established diagnostic tumour marker, CA19-9. Risk factors, symptoms and circulating biomarkers associated with a PDAC diagnosis may differ from those that alter disease progression and metastasis. This study aimed at assessing the risk factors, presenting symptoms and potential prognostic biomarkers in PDAC and determine their relationship with PDAC stage and/or metastatic status.
Seventy-two PDAC patients with imaging available for TNM staging at presentation were enrolled following informed consent. Demographic and clinical data were captured. Blood was collected and 38 cytokines/angiogenic factors measured. Nonparametric association tests, univariate and multivariate logistic regression were performed using STATA version 14.2. A p-value≤0.05 was considered significant and odds ratios reported for effect size.
Most risk factors and symptoms did not differ across the stages of cancer. Although male gender and smoking are risk factors for PDAC, the majority of study patients with metastatic PDAC were non-smoking females. In addition to CA19-9, the platelet count (p<0.01), IL-15 (p = 0.02) and GM-CSF (p<0.01) were significant, independent negative predictors of metastatic PDAC. Moreover, using specific cut-off values in a combined panel, the odds in a patient with all three biomarker levels below the cut-offs is 21 times more likely to have metastatic PDAC (p<0.0001).
Platelet count, IL-15 and GM-CSF are potential prognostic indicators of metastatic disease in PDAC patients from our local South African population.
背景/目的：胰腺导管腺癌（PDAC）是一种侵袭性恶性肿瘤，具有很高的转移风险。即使在手术后，预后仍然很差。此前，我们的研究小组发现了一些生物标志物，可以提高 PDAC 的诊断准确性，超过了现有的诊断肿瘤标志物 CA19-9。与改变疾病进展和转移相关的 PDAC 诊断的危险因素、症状和循环生物标志物可能与那些不同。本研究旨在评估 PDAC 的危险因素、表现症状和潜在的预后生物标志物，并确定它们与 PDAC 分期和/或转移状态的关系。
在知情同意的情况下，共纳入了 72 名有影像学资料可供 TNM 分期的 PDAC 患者。收集人口统计学和临床数据。采集血液并测量 38 种细胞因子/血管生成因子。使用 STATA 版本 14.2 进行非参数关联检验、单变量和多变量逻辑回归。p 值≤0.05 被认为具有统计学意义，并报告了效应大小的优势比。
大多数危险因素和症状在癌症各阶段没有差异。尽管男性和吸烟是 PDAC 的危险因素，但大多数患有转移性 PDAC 的研究患者是不吸烟的女性。除了 CA19-9 之外，血小板计数（p<0.01）、IL-15（p = 0.02）和 GM-CSF（p<0.01）也是转移性 PDAC 的显著、独立的阴性预测因子。此外，在一个联合标志物面板中使用特定的截断值，所有三个标志物水平均低于截断值的患者患有转移性 PDAC 的几率是 21 倍（p<0.0001）。
血小板计数、IL-15 和 GM-CSF 是南非本地 PDAC 患者转移性疾病的潜在预后指标。
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