Agnieszka Budzynska, Ewa Nowakowska-Dulawa, Tomasz Marek and Marek Hartleb
Objective: To determine the value of serum and bile insulin-like growth factor I (IGF-I), interleukin-6 (Il-6) and tumor M2-pyruvate kinase (Tu M2-PK) in distinguishing pancreatobiliary cancers from benign biliary strictures.
Material and methods: The study was performed prospectively on forty jaundiced patients admitted for biliary decompression due to bile duct strictures. Malignant strictures were diagnosed in 22 patients including 15 cases of CCA and 7 cases of pancreatic cancer, and benign biliary strictures in 18 cases. IGF-I, Il-6 and Tu M2-PK were measured in sera and bile by ELISA and compared to serum levels of carbohydrate antigens (CA) 19-9 and carcinoembryonic antigen (CEA).
Results: Serum levels of IGF-I (74.4 vs. 117.0 ng/mL, p=0.03), Il-6 (37.1 vs. 17.0 pg/mL, p=0.04), CA19-9 (5689 vs. 38.9 U/mL, p<0.001) and CEA (27.5 vs. 1.9 ng/mL, p<0.0001) differed significantly between patients with malignant and benign biliary strictures, whereas biliary concentrations of IGF-I and Il-6 and serum and biliary levels of Tu M2-PK were comparable. Biliary IGF-I levels were significantly increased in pancreatic cancer as compared to cholangiocarcinoma and benign biliary strictures groups (966 vs. 137 ng/mL, p=0.03 and 966 vs. 90.6 ng/mL, p=0.01, respectively). The AUC-ROCs for serum IGF-I and serum Il-6 were 0.336 and 0.606, respectively, what was worse than that of CA 19-9 (0.855) and CEA (0.794).
Conclusion: Measurement of serum IGF-I and Il-6 may be helpful in differentiation malignant from benign biliary strictures and biliary IGF-I seems to be a promising marker for distinguishing pancreatic cancer from cholangiocarcinoma and benign biliary occlusions.
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