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Pancreatic cancer

Mass spectrometry indicates malignant potential

Nature Reviews Clinical Oncology volume 15, page 67 (2018)Cite this article

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Pancreatic cyst lesions (PCLs) can be incidentally observed in up to 20% of patients undergoing abdominal MRI; although the majority of these lesions are entirely asymptomatic, current measures are often unable to discriminate between benign lesions and their malignant counterparts, which necessitate therapeutic intervention. Now, the findings of a phase II trial reveal the superiority of proteomic quantifications of three biomarkers in cyst-fluid samples over standard analyses (quantification of carcinoembryonic antigen (CEA) levels and cytology) in detecting malignant PCLs.

Researchers initially identified candidate biomarkers using cyst-fluid samples from patients in the exploratory cohort. Candidate biomarkers were limited to secreted and plasma membrane proteins only, and labelled peptides were then developed for the eight most promising candidates. In the training cohort, mucin 5AC proved to be the best marker for the presence of cystic cancer. When incorporated into a biomarker panel with mucin 2, this combination had a diagnostic accuracy for malignant potential of 97% versus 61% for CEA and 84% for cytology in the validation cohort, although many samples could not be analysed using either CEA or cytology owing to the need for higher volumes of cyst fluid. In combination with prostate stem cell antigen (PSCA), mucin 5AC enabled similarly high levels of detection of high-grade dysplasia and/or cancer in 95% of lesions compared with 35% for CEA and 50% for cytology.

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References

  1. Jabbar, K. S. et al. Highly accurate identification of cystic precursor lesions of pancreatic cancer through targeted mass spectrometry: a phase IIc diagnostic study. J. Clin. Oncol. http://dx.doi.org/10.1200/JCO.2017.73.7288 (2017)

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  1. Peter Sidaway
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Sidaway, P. Mass spectrometry indicates malignant potential. Nat Rev Clin Oncol 15, 67 (2018). https://doi.org/10.1038/nrclinonc.2017.199

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