Skip to main content

Advertisement

Log in

Serum biomarkers for improved diagnostic of pancreatic cancer: a current overview

  • Review
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Complete resection constitutes the only curative approach in pancreatic cancer but is possible only in a minority of patients due to advanced stages upon diagnosis. Consequently, early detection is crucial for curative treatment. Clinical routine still lacks efficient, non-invasive screening assays, and 80–90% of pancreatic carcinomas are detected at unresectable stages. A wide range of serum proteins have been in the focus of intensive search for biomarkers specific for pancreatic cancer. This article will give an overview on serum biomarkers with screening potential for pancreatic malignancy.

Design and methods

PUBMED database was searched for articles, and 43 manuscripts were selected that provided data regarding biomarkers used, type of assay, study population, sample cohort quality and diagnostic performance.

Results

Superior values for diagnostic performance were shown for MIC-1, PAM4, OPN, HSP27, TPS, TSGF, and CAM17.1 as individual markers. Panels of biomarkers comprised CA 19-9, MCSF, CEA, SAA, Haptoglobin, TSGF, CA 242, and HSP27. Individually or in concerted form, sensitivity and specificity ranged from 77 to 100% and 84–100%, respectively.

Conclusions

While the above named markers show high screening potential for pancreatic cancer, standardized validation studies using multiplex assays are required to pave the way for clinical routine application.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  • Banfi G, Zerbi A, Pastori S, Parolini D, Di Carlo V, Bonini P (1993) Behavior of tumor markers CA19.9, CA195, CAM43, CA242, and TPS in the diagnosis and follow-up of pancreatic cancer. Clin Chem 39:420–423

    CAS  PubMed  Google Scholar 

  • Benson AB 3rd (2007) Adjuvant therapy for pancreatic cancer: one small step forward. JAMA 297:311–313

    Article  CAS  PubMed  Google Scholar 

  • Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Lijmer JG, Moher D, Rennie D, de Vet HC (2003) Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Standards for Reporting of Diagnostic Accuracy. Clin Chem 49:1–6

    Article  CAS  PubMed  Google Scholar 

  • Brazma A, Hingamp P, Quackenbush J, Sherlock G, Spellman P, Stoeckert C, Aach J, Ansorge W, Ball CA, Causton HC et al (2001) Minimum information about a microarray experiment (MIAME)-toward standards for microarray data. Nat Genet 29:365–371

    Article  CAS  PubMed  Google Scholar 

  • Brenner H, Hakulinen T (2009) Up-to-date cancer survival: period analysis and beyond. Int J Cancer 124:1384–1390

    Article  CAS  PubMed  Google Scholar 

  • Cwik G, Wallner G, Skoczylas T, Ciechanski A, Zinkiewicz K (2006) Cancer antigens 19-9 and 125 in the differential diagnosis of pancreatic mass lesions. Arch Surg 141:968–973 ;(discussion 974)

    Google Scholar 

  • Duraker N, Hot S, Polat Y, Hobek A, Gencler N, Urhan N (2007) CEA, CA 19-9, and CA 125 in the differential diagnosis of benign and malignant pancreatic diseases with or without jaundice. J Surg Oncol 95:142–147

    Article  CAS  PubMed  Google Scholar 

  • Ehmann M, Felix K, Hartmann D, Schnolzer M, Nees M, Vorderwulbecke S, Bogumil R, Buchler MW, Friess H (2007) Identification of potential markers for the detection of pancreatic cancer through comparative serum protein expression profiling. Pancreas 34:205–214

    Article  CAS  PubMed  Google Scholar 

  • Fiedler GM, Leichtle AB, Kase J, Baumann S, Ceglarek U, Felix K, Conrad T, Witzigmann H, Weimann A, Schutte C et al (2009) Serum peptidome profiling revealed platelet factor 4 as a potential discriminating peptide associated with pancreatic cancer. Clin Cancer Res 15:3812–3819

    Article  CAS  PubMed  Google Scholar 

  • Firpo MA, Gay DZ, Granger SR, Scaife CL, DiSario JA, Boucher KM, Mulvihill SJ (2009) Improved diagnosis of pancreatic adenocarcinoma using haptoglobin and serum amyloid A in a panel screen. World J Surg 33:716–722

    Article  PubMed  Google Scholar 

  • Frederiksen CB, Lomholt AF, Lottenburger T, Davis GJ, Dowell BL, Blankenstein MA, Christensen IJ, Brunner N, Nielsen HJ (2008) Assessment of the biological variation of plasma tissue inhibitor of metalloproteinases-1. Int J Biol Markers 23:42–47

    CAS  PubMed  Google Scholar 

  • Galasso D, Carnuccio A, Larghi A (2010) Pancreatic cancer: diagnosis and endoscopic staging. Eur Rev Med Pharmacol Sci 14:375385

    Google Scholar 

  • Gansauge F, Gansauge S, Parker N, Beger MI, Poch B, Link KH, Safi F, Beger HG (1996) CAM 17.1—a new diagnostic marker in pancreatic cancer. Br J Cancer 74:1997–2002

    Article  CAS  PubMed  Google Scholar 

  • Ghaneh P, Costello E, Neoptolemos JP (2007) Biology and management of pancreatic cancer. Gut 56:1134–1152

    Article  CAS  PubMed  Google Scholar 

  • Gold DV, Goggins M, Modrak DE, Newsome G, Liu M, Shi C, Hruban R, Goldenberg DM (2010) Detection of early-stage pancreatic adenocarcinoma. Cancer Epidemiol Biomarkers Prev

  • Goodwin RJ, Dungworth JC, Cobb SR, Pitt AR (2008) Time-dependent evolution of tissue markers by MALDI-MS imaging. Proteomics 8:3801–3808

    Article  CAS  PubMed  Google Scholar 

  • Goonetilleke KS, Siriwardena AK (2007) Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer. Eur J Surg Oncol 33:266–270

    Article  CAS  PubMed  Google Scholar 

  • Groblewska M, Mroczko B, Wereszczynska-Siemiatkowska U, Mysliwiec P, Kedra B, Szmitkowski M (2007) Serum levels of granulocyte colony-stimulating factor (G-CSF) and macrophage colony-stimulating factor (M-CSF) in pancreatic cancer patients. Clin Chem Lab Med 45:30–34

    Article  CAS  PubMed  Google Scholar 

  • Haglund C, Lundin J, Kuusela P, Roberts PJ (1994) CA 242, a new tumour marker for pancreatic cancer: a comparison with CA 19-9, CA 50 and CEA. Br J Cancer 70:487–492

    Article  CAS  PubMed  Google Scholar 

  • Holten-Andersen MN, Schrohl AS, Brunner N, Nielsen HJ, Hogdall CK, Hogdall EV (2003) Evaluation of sample handling in relation to levels of tissue inhibitor of metalloproteinases-1 measured in blood by immunoassay. Int J Biol Markers 18:170–176

    CAS  PubMed  Google Scholar 

  • Jiang JT, Wu CP, Deng HF, Lu MY, Wu J, Zhang HY, Sun WH, Ji M (2004a) Serum level of TSGF, CA242 and CA19-9 in pancreatic cancer. World J Gastroenterol 10:1675–1677

    CAS  PubMed  Google Scholar 

  • Jiang XT, Tao HQ, Zou SC (2004b) Detection of serum tumor markers in the diagnosis and treatment of patients with pancreatic cancer. Hepatobiliary Pancreat Dis Int 3:464–468

    CAS  PubMed  Google Scholar 

  • Joergensen MT, Brunner N, De Muckadell OB (2010) Comparison of circulating MMP-9, TIMP-1 and CA19-9 in the detection of pancreatic cancer. Anticancer Res 30:587–592

    Google Scholar 

  • Katz MH, Hwang R, Fleming JB, Evans DB (2008) Tumor-node-metastasis staging of pancreatic adenocarcinoma. CA Cancer J Clin 58:111–125

    Article  PubMed  Google Scholar 

  • Koopmann J, Buckhaults P, Brown DA, Zahurak ML, Sato N, Fukushima N, Sokoll LJ, Chan DW, Yeo CJ, Hruban RH et al (2004a) Serum macrophage inhibitory cytokine 1 as a marker of pancreatic and other periampullary cancers. Clin Cancer Res 10:2386–2392

    Article  CAS  PubMed  Google Scholar 

  • Koopmann J, Fedarko NS, Jain A, Maitra A, Iacobuzio-Donahue C, Rahman A, Hruban RH, Yeo CJ, Goggins M (2004b) Evaluation of osteopontin as biomarker for pancreatic adenocarcinoma. Cancer Epidemiol Biomarkers Prev 13:487–491

    CAS  PubMed  Google Scholar 

  • Koopmann J, Rosenzweig CN, Zhang Z, Canto MI, Brown DA, Hunter M, Yeo C, Chan DW, Breit SN, Goggins M (2006) Serum markers in patients with resectable pancreatic adenocarcinoma: macrophage inhibitory cytokine 1 versus CA19-9. Clin Cancer Res 12:442–446

    Article  CAS  PubMed  Google Scholar 

  • Liao Q, Zhao YP, Yang YC, Li LJ, Long X, Han SM (2007) Combined detection of serum tumor markers for differential diagnosis of solid lesions located at the pancreatic head. Hepatobiliary Pancreat Dis Int 6:641–645

    CAS  PubMed  Google Scholar 

  • Liao WC, Wu MS, Wang HP, Tien YW, Lin JT (2009) Serum heat shock protein 27 is increased in chronic pancreatitis and pancreatic carcinoma. Pancreas 38:422–426

    Article  CAS  PubMed  Google Scholar 

  • Liu RC, Traverso LW (2005) Diagnostic laparoscopy improves staging of pancreatic cancer deemed locally unresectable by computed tomography. Surg Endosc 19:638–642

    Article  CAS  PubMed  Google Scholar 

  • Mayo SC, Austin DF, Sheppard BC, Mori M, Shipley DK, Billingsley KG (2009) Evolving preoperative evaluation of patients with pancreatic cancer: does laparoscopy have a role in the current era? J Am Coll Surg 208:87–95

    Article  PubMed  Google Scholar 

  • McCarthy MJ, Evans J, Sagar G, Neoptolemos JP (1998) Prediction of resectability of pancreatic malignancy by computed tomography. Br J Surg 85:320–325

    Article  CAS  PubMed  Google Scholar 

  • McShane LM, Altman DG, Sauerbrei W, Taube SE, Gion M, Clark GM (2005) REporting recommendations for tumour MARKer prognostic studies (REMARK). Br J Cancer 93:387–391

    Article  CAS  PubMed  Google Scholar 

  • McSweeney SE, O’Donoghue PM, Jhaveri K (2010) Current and emerging techniques in gastrointestinal imaging. J Postgrad Med 56:109–116

    Google Scholar 

  • Melle C, Ernst G, Escher N, Hartmann D, Schimmel B, Bleul A, Thieme H, Kaufmann R, Felix K, Friess HM et al (2007) Protein profiling of microdissected pancreas carcinoma and identification of HSP27 as a potential serum marker. Clin Chem 53:629–635

    Article  CAS  PubMed  Google Scholar 

  • Mroczko B, Lukaszewicz-Zajac M, Wereszczynska-Siemiatkowska U, Groblewska M, Gryko M, Kedra B, Jurkowska G, Szmitkowski M (2009) Clinical significance of the measurements of serum matrix metalloproteinase-9 and its inhibitor (tissue inhibitor of metalloproteinase-1) in patients with pancreatic cancer: metalloproteinase-9 as an independent prognostic factor. Pancreas 38:613–618

    Article  CAS  PubMed  Google Scholar 

  • Ni XG, Bai XF, Mao YL, Shao YF, Wu JX, Shan Y, Wang CF, Wang J, Tian YT, Liu Q et al (2005) The clinical value of serum CEA, CA19-9, and CA242 in the diagnosis and prognosis of pancreatic cancer. Eur J Surg Oncol 31:164–169

    Article  CAS  PubMed  Google Scholar 

  • Nieto J, Grossbard ML, Kozuch P (2008) Metastatic pancreatic cancer 2008: is the glass less empty? Oncologist 13:562–576

    Article  CAS  PubMed  Google Scholar 

  • Ozkan H, Akar T, Koklu S, Coban S (2006) Significance of serum receptor-binding cancer antigen (RCAS1) in pancreatic cancer and benign pancreatobiliary diseases. Pancreatology 6:268–272

    Article  CAS  PubMed  Google Scholar 

  • Pasanen PA, Eskelinen M, Partanen K, Pikkarainen P, Penttila I, Alhava E (1994) A prospective study of serum tumour markers carcinoembryonic antigen, carbohydrate antigens 50 and 242, tissue polypeptide antigen and tissue polypeptide specific antigen in the diagnosis of pancreatic cancer with special reference to multivariate diagnostic score. Br J Cancer 69:562–565

    Article  CAS  PubMed  Google Scholar 

  • Pieragostino D, Petrucci F, Del Boccio P, Mantini D, Lugaresi A, Tiberio S, Onofrj M, Gambi D, Sacchetta P, Di Ilio C et al (2010) Pre-analytical factors in clinical proteomics investigations: impact of ex vivo protein modifications for multiple sclerosis biomarker discovery. J Proteomics 73:579–592

    Google Scholar 

  • Rosch T, Lightdale CJ, Botet JF, Boyce GA, Sivak MV Jr, Yasuda K, Heyder N, Palazzo L, Dancygier H, Schusdziarra V et al (1992) Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N Engl J Med 326:1721–1726

    Article  CAS  PubMed  Google Scholar 

  • Rouy D, Ernens I, Jeanty C, Wagner DR (2005) Plasma storage at −80 degree C does not protect matrix metalloproteinase-9 from degradation. Anal Biochem 338:294–298

    Article  CAS  PubMed  Google Scholar 

  • Schrohl AS, Wurtz S, Kohn E, Banks RE, Nielsen HJ, Sweep FC, Brunner N (2008) Banking of biological fluids for studies of disease-associated protein biomarkers. Mol Cell Proteomics 7:2061–2066

    Article  CAS  PubMed  Google Scholar 

  • Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol 63:834–840

    Article  PubMed  Google Scholar 

  • Simeone DM, Ji B, Banerjee M, Arumugam T, Li D, Anderson MA, Bamberger AM, Greenson J, Brand RE, Ramachandran V et al (2007) CEACAM1, a novel serum biomarker for pancreatic cancer. Pancreas 34:436–443

    Article  CAS  PubMed  Google Scholar 

  • Sultana A, Smith CT, Cunningham D, Starling N, Neoptolemos JP, Ghaneh P (2007) Meta-analyses of chemotherapy for locally advanced and metastatic pancreatic cancer. J Clin Oncol 25:2607–2615

    Article  PubMed  Google Scholar 

  • Takayama R, Nakagawa H, Sawaki A, Mizuno N, Kawai H, Tajika M, Yatabe Y, Matsuo K, Uehara R, Ono K et al (2010) Serum tumor antigen REG4 as a diagnostic biomarker in pancreatic ductal adenocarcinoma. J Gastroenterol 45:52–59

    Article  CAS  PubMed  Google Scholar 

  • Taylor CF, Paton NW, Lilley KS, Binz PA, Julian RK Jr, Jones AR, Zhu W, Apweiler R, Aebersold R, Deutsch EW et al (2007) The minimum information about a proteomics experiment (MIAPE). Nat Biotechnol 25:887–893

    Article  CAS  PubMed  Google Scholar 

  • Thurigen D, Spiegelman D, Blettner M, Heuer C, Brenner H (2000) Measurement error correction using validation data: a review of methods and their applicability in case–control studies. Stat Methods Med Res 9:447–474

    Article  CAS  PubMed  Google Scholar 

  • Ventrucci M, Cipolla A, Racchini C, Casadei R, Simoni P, Gullo L (2004) Tumor M2-pyruvate kinase, a new metabolic marker for pancreatic cancer. Dig Dis Sci 49:1149–1155

    Article  CAS  PubMed  Google Scholar 

  • Wu X, Lu XH, Xu T, Qian JM, Zhao P, Guo XZ, Yang XO, Jiang WJ (2006) Evaluation of the diagnostic value of serum tumor markers, and fecal k-ras and p53 gene mutations for pancreatic cancer. Chin J Dig Dis 7:170–174

    Article  PubMed  Google Scholar 

  • Yiannakou JY, Newland P, Calder F, Kingsnorth AN, Rhodes JM (1997) Prospective study of CAM 17.1/WGA mucin assay for serological diagnosis of pancreatic cancer. Lancet 349:389–392

    Article  CAS  PubMed  Google Scholar 

  • Zhao YP, Zhang TP (2008) Present status of and prospects for basic research on pancreatic cancer. Zhonghua Yi Xue Za Zhi 88:1945–1947

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We declare that we have no conflict of interest. Grants from the Ad Infinitum Foundation, the Werner and Clara Kreitz Foundation and the H.W. & J. Hector Foundation are gratefully acknowledged. This review was performed in collaboration with the “North German Tumorbank of Colorectal Cancer” (DKH #108446) and the biobank “ColonBiomics” being integral part of the Surgical Center for Translational Oncology-Lübeck (SCTO-L).

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J. K. Habermann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bünger, S., Laubert, T., Roblick, U.J. et al. Serum biomarkers for improved diagnostic of pancreatic cancer: a current overview. J Cancer Res Clin Oncol 137, 375–389 (2011). https://doi.org/10.1007/s00432-010-0965-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-010-0965-x

Keywords

Navigation