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Open Access Highly Accessed Research article

Validation of four candidate pancreatic cancer serological biomarkers that improve the performance of CA19.9

Shalini Makawita1, Apostolos Dimitromanolakis3, Antoninus Soosaipillai3, Ireena Soleas3, Alison Chan1, Steven Gallinger24, Randy S Haun5, Ivan M Blasutig16 and Eleftherios P Diamandis1367*

Author Affiliations

1 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

2 Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada

3 Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada

4 Zane Cohen Familial Gastrointestinal Cancer Registry, Mount Sinai Hospital, Toronto, ON, Canada

5 Department of Pharmaceutical Sciences, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, AR, USA

6 Department of Clinical Biochemistry, University Health Network, Toronto, ON, Canada

7 Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, 6th Floor, Room 6-201, Box 32, 60 Murray Street, Toronto, ON M5T 3L9, Canada

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BMC Cancer 2013, 13:404  doi:10.1186/1471-2407-13-404

Published: 3 September 2013



The identification of new serum biomarkers with high sensitivity and specificity is an important priority in pancreatic cancer research. Through an extensive proteomics analysis of pancreatic cancer cell lines and pancreatic juice, we previously generated a list of candidate pancreatic cancer biomarkers. The present study details further validation of four of our previously identified candidates: regenerating islet-derived 1 beta (REG1B), syncollin (SYCN), anterior gradient homolog 2 protein (AGR2), and lysyl oxidase-like 2 (LOXL2).


The candidate biomarkers were validated using enzyme-linked immunosorbent assays in two sample sets of serum/plasma comprising a total of 432 samples (Sample Set A: pancreatic ductal adenocarcinoma (PDAC, n = 100), healthy (n = 92); Sample Set B: PDAC (n = 82), benign (n = 41), disease-free (n = 47), other cancers (n = 70)). Biomarker performance in distinguishing PDAC from each control group was assessed individually in the two sample sets. Subsequently, multiparametric modeling was applied to assess the ability of all possible two and three marker panels in distinguishing PDAC from disease-free controls. The models were generated using sample set B, and then validated in Sample Set A.


Individually, all markers were significantly elevated in PDAC compared to healthy controls in at least one sample set (p ≤ 0.01). SYCN, REG1B and AGR2 were also significantly elevated in PDAC compared to benign controls (p ≤ 0.01), and AGR2 was significantly elevated in PDAC compared to other cancers (p < 0.01). CA19.9 was also assessed. Individually, CA19.9 showed the greatest area under the curve (AUC) in receiver operating characteristic (ROC) analysis when compared to the tested candidates; however when analyzed in combination, three panels (CA19.9 + REG1B (AUC of 0.88), CA19.9 + SYCN + REG1B (AUC of 0.87) and CA19.9 + AGR2 + REG1B (AUC of 0.87)) showed an AUC that was significantly greater (p < 0.05) than that of CA19.9 alone (AUC of 0.82). In a comparison of early-stage (Stage I-II) PDAC to disease free controls, the combination of SYCN + REG1B + CA19.9 showed the greatest AUC in both sample sets, (AUC of 0.87 and 0.92 in Sets A and B, respectively).


Additional serum biomarkers, particularly SYCN and REG1B, when combined with CA19.9, show promise as improved diagnostic indicators of pancreatic cancer, which therefore warrants further validation.

Pancreatic cancer; Serum biomarkers; Biomarker validation; ELISA; Biomarker panel