title: Diagnostic and prognostic value of plasma tumor M2 pyruvate kinase in periampullary cancer: evidence for a novel biological marker of adverse prognosis.
abstract: OBJECTIVE
  This prospective study examines the diagnostic and prognostic use of tumor-M2-pyruvate kinase (Tu-M2-PK) used in conjunction with carbohydrate antigen (CA) 19-9 in patients with subsequently histologically confirmed periampullary malignancy.
  
  
  METHODS
  Plasma Tu-M2-PK and serum CA 19-9 levels were measured at admission in a cohort of patients with suspected pancreatic cancer. Values for Tu-M2-PK and serum CA 19-9 were compared with a control group comprising jaundiced patients in whom malignancy was excluded by endoscopic retrograde cholangiopancreatography and nonjaundiced individuals undergoing laparoscopic cholecystectomy.
  
  
  RESULTS
  The mean (SD) plasma Tu-M2-PK level for patients with histologically proven malignancy was 40.5 (26.4) U/mL and for noncancer patients, 29.9 (20.9) U/mL (Mann-Whitney U = 1163, P = 0.006). Tumor-M2-pyruvate kinase had an area under the curve of 0.623 on receiver operating characteristic curve analysis, and at optimal cutoff of 27 U/mL, sensitivity is 66%, and specificity is 58%.However, on multivariate Cox regression modeling, elevated Tu-M2-PK (>27 U/mL) was strongly correlated with the subsequent finding of poorly differentiated cancer and/or metastatic disease and strongly predicted survival on Kaplan-Meier analysis.
  
  
  CONCLUSIONS
  An elevated Tu-M2-PK more than 27 U/mL measured on admission in suspected periampullary cancer is a predictor of adverse prognosis in periampullary cancer.
authors.affiliation: Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: Kolitha S
authors.initials: KS
authors.lastname: Goonetilleke
authors.forename: James M
authors.initials: JM
authors.lastname: Mason
authors.forename: Priyantha
authors.initials: P
authors.lastname: Siriwardana
authors.forename: Nicholas K
authors.initials: NK
authors.lastname: King
authors.forename: Michael W
authors.initials: MW
authors.lastname: France
authors.forename: Ajith K
authors.initials: AK
authors.lastname: Siriwardena
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000201:enzymology* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D011770:Pyruvate Kinase / Q000097:blood* / Q000378:metabolism*; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor; D011770:Pyruvate Kinase