Plasma soluble urokinase-type plasminogen activator receptor (P-suPAR) in the diagnostics between malignant and non-malignant pancreatic lesions

Anu Aronen; Janne Aittoniemi; Reetta Huttunen; Anssi Nikkola; Jussi Nikkola; Olli Limnell; Juhani Sand; Johanna Laukkarinen

doi:10.1016/j.pan.2022.12.012

Plasma soluble urokinase-type plasminogen activator receptor (P-suPAR) in the diagnostics between malignant and non-malignant pancreatic lesions

Pancreatology. 2023 Mar;23(2):213-217. doi: 10.1016/j.pan.2022.12.012. Epub 2022 Dec 24.

Authors

Anu Aronen¹, Janne Aittoniemi², Reetta Huttunen³, Anssi Nikkola¹, Jussi Nikkola¹, Olli Limnell⁴, Juhani Sand¹, Johanna Laukkarinen⁵

Affiliations

¹ Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
² Fimlab Laboratories, Tampere, Finland.
³ Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Internal Medicine, Tampere University Hospital, Finland.
⁴ Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
⁵ Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. Electronic address: johanna.laukkarinen@fimnet.fi.

PMID: 36596714
DOI: 10.1016/j.pan.2022.12.012

Abstract

Background: Soluble urokinase-type plasminogen activator receptor (suPAR) is a biomarker elevated in several inflammatory conditions and cancers. It has recently been shown to be elevated in pancreatic ductal adenocarcinoma (PDAC). Plasma suPAR (P-suPAR) predicts the severity of the disease in first acute alcohol-induced pancreatitis (AAP) and ten-year mortality after recovery from first AAP. According to our previous results, P-suPAR is not elevated in chronic pancreatitis (CP) and could possibly be used in distinguishing pancreatic cancer (PC) from CP. When imaging creates a suspicion of a pancreatic lesion, the distinction between malignant and non-malignant disease is crucial. Additional tools are needed, and we still lack a sufficiently sensitive and specific biomarker. Our aim was to further investigate whether preoperatively measured P-suPAR is beneficial in distinguishing between malignant and non-malignant pancreatic lesions.

Methods: One hundred and seventy-six patients evaluated in Tampere University Hospital for pancreatic surgery for suspected malignant pancreatic lesion were recruited for the study. The final study group consisted of 113 patients. P-suPAR and other covariates were measured before the planned operation.

Results: P-suPAR was significantly higher in patients with pancreatic cancer (PC) [median 4.1 (IQR 3.3-5.1) ng/mL] than in patients with non-malignant [3.3 (2.9-4.4) ng/mL; p = 0.012] histology. ROC curve analysis resulted in an AUC of 0.65 (95% CI 0.55-0.76); p = 0.007 and a cutoff value of 3.2 ng/mL. Crosstabulation yielded sensitivity of 82% and specificity of 43%. A combination of positive P-suPAR and elevated plasma carbohydrate antigen 19-9 (P-CA19-9) tests did not improve sensitivity but elevated specificity up to 86-88%.

Conclusions: Preoperative P-suPAR is elevated in patients with PC compared to patients with a non-malignant pancreatic lesion. Combining P-suPAR with P-CA19-9 may improve diagnostic accuracy.

Keywords: Biomarkers; Inflammation; Pancreatic cancer; Pancreatic diseases; Plasminogen activator receptor; Urokinase type.

MeSH terms

Biomarkers
CA-19-9 Antigen
Humans
Pancreatic Neoplasms*
Pancreatitis, Alcoholic* / diagnosis
Prognosis
Receptors, Urokinase Plasminogen Activator

Substances

Receptors, Urokinase Plasminogen Activator
CA-19-9 Antigen
Biomarkers