Role of circulating exosomal biomarkers and their diagnostic accuracy in pancreatic cancer

• Published in: JGH open Vol. 7; no. 1; pp. 30 - 39
• Main Authors: Sha, Menazir, Kunduzi, Basir, Froghi, Saied, Quaglia, Alberto, Davidson, Brian, Fusai, Giuseppe K
• Format: Journal Article
• Language: English
• Published: Melbourne Wiley Publishing Asia Pty Ltd 01-01-2023; John Wiley & Sons, Inc; Wiley
• Subjects: Biomarkers; cancer biomarker; exosomal biomarker; Medical prognosis; Metabolites; Original; Pancreatic cancer; Software; cancer biomarker; pancreatic cancer; exosomal biomarker
• ISSN: 2397-9070; 2397-9070
• DOI: 10.1002/jgh3.12848

Background and Aim
New biomarkers have the potential to facilitate early diagnosis of pancreatic cancer (PC). Circulating exosomes are cell‐derived protein complexes containing RNA that can be used as indicators of cancer development. The aim of this review is to evaluate the current literature involving PC patient groups for highly accurate exosomal biomarkers.
Methods
The literature search followed Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Eight‐hundred and seventy‐five studies were identified across various databases (Ovid MEDLINE, Embase, and Cochrane) published between 2009 and 2020. Nine studies fulfilled the inclusion criteria: human PC patients, diagnosis as outcome of interest, serum biomarker of exosomal content, reporting of diagnostic values, and disease progress. Area under the curve (AUC) of the exosomal biomarker was compared against that of CA19‐9.
Results
Nine papers were reviewed for relevant outcomes based on the inclusion criteria. These studies involved 565 participants (331 PC, 234 controls; male/female ratio 1.21; mean age 64.1). Tumor staging was reported in all studies, with 45.6% of PC patients diagnosed with early‐stage PC (T1–2). The mRNA panel (ARG1, CD63, CK18, Erbb3, GAPDH, H3F3A, KRAS, ODC1) and GPC 1 reported the highest performing sensitivity and specificity at 100% each. The microRNA panel (miR‐10b, miR‐21, miR‐30c, miR‐181a, and miR‐let7a), mRNA panel (ARG1, CD63, CK18, Erbb3, GAPDH, H3F3A, KRAS, ODC1), and GPC 1 showed a perfect AUC of 1.0. Five studies compared the AUC of the exosomal biomarker against CA19‐9, each being superior to that of CA19‐9.
Conclusion
The potential of exosomal biomarkers remains promising in PC diagnosis. Standardization of future studies will allow for larger comparative analyses and overcoming contrasting findings.
This systematic review aims to evaluate the current literature involving pancreatic cancer patient groups in search of highly accurate exosomal biomarkers. We reviewed 9 studies which involved 565 participants (331 PC and 234 controls). The mRNA panel (ARG1, CD63, CK18, Erbb3, GAPDH, H3F3A, KRAS, and ODC1) and GPC1 reported the highest performing sensitivity and specificity at 100% each.