Liquid Biopsy as Surrogate for Tissue for Molecular Profiling in Pancreatic Cancer: A Meta-Analysis Towards Precision Medicine

Abstract

Liquid biopsy (LB) is a non-invasive approach representing a promising tool for new precision medicine strategies for cancer treatment. However, a comprehensive analysis of its reliability for pancreatic cancer (PC) is lacking. To this aim, we performed the first meta-analysis on this topic. We calculated the pooled sensitivity, specificity, positive (LR+) and negative (LR−) likelihood ratio, and diagnostic odds ratio (DOR). A summary receiver operating characteristic curve (SROC) and area under curve (AUC) were used to evaluate the overall accuracy. We finally assessed the concordance rate of all mutations detected by multi-genes panels. Fourteen eligible studies involving 369 patients were included. The overall pooled sensitivity and specificity were 0.70 and 0.86, respectively. The LR+ was 3.85, the LR- was 0.34 and DOR was 15.84. The SROC curve with an AUC of 0.88 indicated a relatively high accuracy of LB for molecular characterization of PC. The concordance rate of all mutations detected by multi-genes panels was 31.9%. LB can serve as surrogate for tissue in the molecular profiling of PC, because of its relatively high sensitivity, specificity and accuracy. It represents a unique opportunity to be further explored towards its introduction in clinical practice and for developing new precision medicine approaches against PC.

Circulating Cell-Free DNA-Based Liquid Biopsy Markers for the Non-Invasive Prognosis and Monitoring of Metastatic Pancreatic Cancer

“…Moreover, tumor tissue is only available at diagnosis, but not at different time points of the disease to monitor tumor burden during treatment. In this scenario, circulating cell-free DNA (cfDNA)-based liquid biopsy represents a promising non-invasive tool for the diagnosis, prognosis and management of PDAC patients [ 7 ]. Hence, the analysis of KRAS mutations in cfDNA has been proposed as non-invasive surrogate for tissue biopsies in patients with pancreatic cancer [ 8 ].…”

Comparison of Pancreatic Cancer Treatment Outcomes: A Real-World Data Analysis

“…Improvement in LB techniques is urgently needed as is the standardization of LB protocols. However, these techniques are becoming widely recognized as fundamental tools in clinical practice, as highlighted in the meta-analysis conducted by Luchini et al (44).…”

The clinical value of peripheral immune cell counts in pancreatic cancer

“…Moreover, other blood-based markers i.e. circulating tumor cells and tumor-DNA were reported to be associated with survival in pancreatic cancer [8]. This might represent a prospect to link these markers together and study their potential associations.…”

“…[1,2] Nonetheless, how inflammation is linked to metastasis remains elusive. Hematologic parameters, in particular neutrophil-lymphocyte ratio (NLR), were repeatedly shown to negatively impact survival outcome in various tumors including pancreatic cancer [3][4][5][6][7][8]. Additionally, studies have related high NLR to baseline presence and subsequent development of distant metastases in various tumors including non-small cell lung cancer, gastric cancer, and colorectal cancer among others [9][10][11].…”