title: Clinical value of circulating lipocalins and insulin-like growth factor axis in pancreatic cancer diagnosis.
abstract: OBJECTIVE
  Early diagnosis of pancreatic cancer (PC) in diabetic patients is difficult owing to late presentation of symptoms. Hence, finding a marker to identify cancer stage early would be useful to improve survival. We aimed to determine levels of serum retinol binding protein 4 (RBP-4), neutrophil gelatinase-associated lipocalin (NGAL), insulin-like growth factor I (IGF-I), and its binding protein 3 (IGFBP-3) in patients with PC with preexisting type 2 diabetes. Moreover, we assessed their clinical usefulness in PC diagnosis and their association with tumor severity.
  
  
  METHODS
  Twenty-three patients with PC, 32 diabetic patients, and 20 healthy controls were examined. Preoperative and postoperative samples were obtained from 15 patients with PC. Serum insulin, cancer antigen (CA 19-9), RBP-4, NGAL, IGF-I, and IGFBP-3 levels were estimated by enzyme-linked immunosorbent assay.
  
  
  RESULTS
  Significant elevation in the levels of RBP-4 (60.1 [46.3-71.4] ng/mL), NGAL (142 [80-235] ng/mL), and IGF-I (174 [9.3] ng/mL) together with significant reduction in the level of IGFBP-3 (3669 [299] ng/mL) was found in patients with PC. Moreover, RBP-4 and NGAL levels were reduced in postoperative samples compared with preoperative ones. Receiver operating characteristic curve analysis revealed that they can distinguish PC from non-PC cases with significant area under the curve.
  
  
  CONCLUSIONS
  Retinol binding protein 4, NGAL, IGF-I, and IGFBP-3 are associated with PC in type 2 diabetic patients. They could be useful in distinguishing PC from non-PC cases when used in combination or with cancer antigen.
authors.affiliation: Department of Biochemistry, Faculty of Pharmacy, Ain-Shams University, Cairo, Egypt.
authors.forename: Hala O
authors.initials: HO
authors.lastname: El-Mesallamy
authors.forename: Nadia M
authors.initials: NM
authors.lastname: Hamdy
authors.forename: Ashraf S
authors.initials: AS
authors.lastname: Zaghloul
authors.forename: Alaliaa M
authors.initials: AM
authors.lastname: Sallam
mesh_terms: D000209:Acute-Phase Proteins; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000032:analysis*; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D011237:Predictive Value of Tests; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000097:blood*; D012372:ROC Curve; D054839:Retinol-Binding Proteins, Plasma / Q000032:analysis; D015398:Signal Transduction; D015854:Up-Regulation
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D018395:CA-19-9 Antigen; C515497:IGFBP3 protein, human; D007328:Insulin; D018972:Insulin-Like Growth Factor Binding Protein 3; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; C101326:RBP4 protein, human; D054839:Retinol-Binding Proteins, Plasma; D007334:Insulin-Like Growth Factor I