胰液分子生物标志物在诊断胰腺癌中的研究进展

The efficacy of pancreatic fluid molecular biomarkers for diagnosis of pancreatic cancer

胰腺癌(pancreatic cancer,PC)是全世界最致命的恶性肿瘤之一,因其起病隐匿,恶性程度高,致死率高,被称为“癌中之王”。胰腺癌恶性程度高,进展迅速,但起病隐匿,早期症状不典型,常规影像学检查难以发现早期病变,通常只有出现黄疸以及腹部、背部疼痛等症状就诊时胰腺癌才得以发现。手术切除是目前胰腺癌唯一的治愈方案,但由于早期诊断困难,绝大多数患者在确诊时已属于中晚期,失去了手术治愈的机会。研究证实胰腺癌的进展是相对比较缓慢的,其起始的肿瘤细胞至少需要15年才能获得转移能力。因此,如果能够通过肿瘤标志物使胰腺癌得以及时发现,就能够有效提高胰腺癌患者的生存期。目前临床上应用最普遍且诊断价值较高的肿瘤标志物为糖类抗原199 (Carbohydrate antigen199,CA19-9),因约3%~7%的胰腺癌患者为Lewis抗原阴性血型结构而不表达CA19-9等原因,其敏感度仅79%~81%,不能为胰腺癌的诊断提供良好的效能。胰液作为一种肿瘤附近的体液,因其是肿瘤相关生物标志物的良好来源,引起了大量的关注。许多研究证实了胰液中的蛋白质、DNA以及外泌体等物质用以诊断胰腺癌所具有的良好准确性,胰液具有成为胰腺癌诊断的肿瘤标志物来源的良好前景。该文对胰液作为标本诊断胰腺癌的临床价值进行综述。

Pancreatic cancer(PC) is one of the deadliest malignant tumors worldwide,known as the ‘king of cancers' due to its insidious onset,high malignancy,and high mortality rate.PC is highly malignant and progresses rapidly,but its onset is insidious with atypical early symptoms,making it difficult to detect early lesions through conventional imaging studies.It is usually only discovered when symptoms like jaundice,abdominal and back pain occur.Surgical resection is currently the only curative option for PC.However,due to the difficulty in early diagnosis,the majority of patients are already in the middle to late stages at the time of diagnosis,missing the opportunity for surgery.Studies have confirmed that the progression of pancreatic cancer is relatively slow,with the initial tumor cells requiring at least 15 years to gain metastatic ability.Therefore,timely detection of pancreatic cancer through tumor markers could significantly improve the survival rate of patients.The most widely used and diagnostically valuable tumor marker in clinical practice is Carbohydrate antigen 199(CA199).However,due to about 3% ~ 7% of pancreatic cancer patients being Lewis antigen-negative blood types and not expressing CA19-9,its sensitivity is only 79% ~ 81%,which does not provide good efficacy for the diagnosis of pancreatic cancer.Pancreatic juice,as a fluid near the tumor,has attracted much attention as a good source of tumor-related biomarkers.Many studies have confirmed the accuracy of using proteins,DNA,and exosomes in pancreatic juice for the diagnosis of pancreatic cancer,showing great prospects for pancreatic juice as a source of tumor markers for the diagnosis of pancreatic cancer.Therefore,this thesis reviews the efficacy of pancreatic juice as a specimen for the diagnosis of pancreatic cancer.