title: Improved Pancreatic Adenocarcinoma Diagnosis in Jaundiced and Non-Jaundiced Pancreatic Adenocarcinoma Patients through the Combination of Routine Clinical Markers Associated to Pancreatic Adenocarcinoma Pathophysiology.
abstract: BACKGROUND
  There is still no reliable biomarker for the diagnosis of pancreatic adenocarcinoma. Carbohydrate antigen 19-9 (CA 19-9) is a tumor marker only recommended for pancreatic adenocarcinoma follow-up. One of the clinical problems lies in distinguishing between this cancer and other benign pancreatic diseases such as chronic pancreatitis. In this study we will assess the value of panels of serum molecules related to pancreatic cancer physiopathology to determine whether alone or in combination could help to discriminate between these two pathologies.
  
  
  METHODS
  CA 19-9, carcinoembryonic antigen (CEA), C-reactive protein, albumin, insulin growth factor-1 (IGF-1) and IGF binding protein-3 were measured using routine clinical analyzers in a cohort of 47 pancreatic adenocarcinoma, 20 chronic pancreatitis and 15 healthy controls.
  
  
  RESULTS
  The combination of CA 19-9, IGF-1 and albumin resulted in a combined area under the curve (AUC) of 0.959 with 93.6% sensitivity and 95% specificity, much higher than CA 19-9 alone. An algorithm was defined to classify the patients as chronic pancreatitis or pancreatic cancer with the above specificity and sensitivity. In an independent validation group of 20 pancreatic adenocarcinoma and 13 chronic pancreatitis patients, the combination of the four molecules classified correctly all pancreatic adenocarcinoma and 12 out of 13 chronic pancreatitis patients.
  
  
  CONCLUSIONS
  Although this panel of markers should be validated in larger cohorts, the high sensitivity and specificity values and the convenience to measure these parameters in clinical laboratories shows great promise for improving pancreatic adenocarcinoma diagnosis.
authors.affiliation: Clinic Laboratory, Dr. Josep Trueta University Hospital, Girona, Spain.|Department of Biology, University of Girona, Girona, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Ferri
authors.affiliation: Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.|CIBER of Epidemiology and Public Health (CIBERESP), Girona, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Saez
authors.affiliation: Hepato-biliary and Pancreatic Surgery Unit, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), Girona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Figueras
authors.affiliation: Gastroenterology Unit, Dr. Josep Trueta University Hospital, Girona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Fort
authors.affiliation: Gastroenterology Unit, Hospital Santa Caterina, Salt, Girona, Spain.
authors.forename: Miriam
authors.initials: M
authors.lastname: Sabat
authors.affiliation: Hepato-biliary and Pancreatic Surgery Unit, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), Girona, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: López-Ben
authors.affiliation: Department of Biology, University of Girona, Girona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: de Llorens
authors.affiliation: Clinic Laboratory, Dr. Josep Trueta University Hospital, Girona, Spain.
authors.forename: Rosa Núria
authors.initials: RN
authors.lastname: Aleixandre
authors.affiliation: Department of Biology, University of Girona, Girona, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Peracaula
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001663:Bilirubin / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D041781:Jaundice, Obstructive / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D050500:Pancreatitis, Chronic / Q000097:blood / Q000175:diagnosis*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000032:analysis
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; C515497:IGFBP3 protein, human; D018972:Insulin-Like Growth Factor Binding Protein 3; D012709:Serum Albumin; D007334:Insulin-Like Growth Factor I; D002097:C-Reactive Protein; D001663:Bilirubin