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News

MicroRNA biomarkers in whole blood for detection of pancreatic cancer

This week's issue of the Journal of the American Medical Association identified panels of microRNAs for use in diagnosis of pancreatic cancer compared with the cancer antigen 19-9.

News image

Biomarkers for the early diagnosis of patients with pancreatic cancer are needed to improve prognosis.

Dr Nicolai Schultz and colleagues from Denmark and colleagues described differences in microRNA expression in whole blood between patients with pancreatic cancer, chronic pancreatitis, and healthy participants.

The research team identified panels of microRNAs for use in diagnosis of pancreatic cancer compared with the cancer antigen 19-9 (CA19-9).

The team performed a case-control study that included 409 patients with pancreatic cancer, and 25 with chronic pancreatitis who had been included prospectively in the Danish BIOPAC (Biomarkers in Patients with Pancreatic Cancer) study (July 2008-October 2012) plus 312 blood donors as healthy participants.

The microRNA expressions in pretreatment whole blood RNA samples were collected and analyzed in 3 randomly determined subcohorts.

38 microRNAs in whole blood were significantly dysregulated in patients
Journal of the American Medical Association

The discovery cohort included 143 patients with pancreatic cancer, 18 patients with chronic pancreatitis, and 69 healthy participants.

The training cohort included 180 patients with pancreatic cancer, 1 patient with chronic pancreatitis, and 199 healthy participants.

The validation cohort involved 86 patients with pancreatic cancer, 7 patients with chronic pancreatitis, and 44 healthy participants.

The team screended 754 microRNAs in the discovery cohort, and 38 microRNAs in the training cohort, and 13 microRNAs in the validation cohort.

The research team's main outcomes included identification of microRNA panels (classifiers) for diagnosing pancreatic cancer.

The discovery cohort demonstrated that 38 microRNAs in whole blood were significantly dysregulated in patients with pancreatic cancer compared with controls.

The team tested these microRNAs in the training cohort, and 2 diagnostic panels were constructed comprising 4 microRNAs in index I, and 10 in index II.

The test characteristics for the training cohort were index I area under the curve (AUC) of 0.86, sensitivity of 0.85, and specificity of 0.64.

The values for index II were an AUC of 0.93, sensitivity of 0.85, and specificity of 0.85.

The team found that for CA19-9, the AUC was 0.90, with a sensitivity of 0.86, and specificity of 0.99.

Performances were strengthened in the validation cohort by combining panels and CA19-9.

Compared with CA19-9 alone, the AUC for the combination of index I and CA19-9 was significantly higher.

The researchers found that the performance of the panels in patients with stage IA-IIB pancreatic cancer was index I AUC of 0.80.

Index I with CA19-9 had an AUC of 0.83; index II had an AUC of 0.91, and index II with CA19-9 had an AUC of 0.91.

Dr Schultz's team commented, "This study identified 2 diagnostic panels based on microRNA expression in whole blood with the potential to distinguish patients with pancreatic cancer from healthy controls."

"Further research is necessary to understand whether these have clinical implications for early detection of pancreatic cancer and how much this information adds to serum CA19-9."

JAMA 2014: 311(4)
23 January 2014

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