Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Oct 15, 2021; 13(10): 1263-1287
Published online Oct 15, 2021. doi: 10.4251/wjgo.v13.i10.1263
Liquid biopsy approach to pancreatic cancer
Sonia Perales, Carolina Torres, Cristina Jimenez-Luna, Jose Prados, Joaquina Martinez-Galan, Jose Manuel Sanchez-Manas, Octavio Caba
Sonia Perales, Department of Biochemistry and Molecular Biology I, Faculty of Sciences, University of Granada, Granada 18071, Spain
Carolina Torres, Department of Biochemistry and Molecular Biology III and Immunology, Faculty of Sciences, University of Granada, Granada 18071, Spain
Cristina Jimenez-Luna, Jose Prados, Octavio Caba, Institute of Biopathology and Regenerative Medicine (IBIMER), Center of Biomedical Research (CIBM), University of Granada, Granada 18100, Spain
Joaquina Martinez-Galan, Department of Medical Oncology, Hospital Universitario Virgen de las Nieves, Granada 18011, Spain
Jose Manuel Sanchez-Manas, School for International Postgraduate Studies, University of Granada, Granada 18071, Spain
Author contributions: All authors have contributed to the manuscript and agree with the final version of the manuscript; Perales S, Torres C and Caba O contributed to conceptualization and design; Prados J, Martinez-Galan J, Luna C and Sanchez-Manas JM collected the data; All authors participated in drafting the article and revising it critically, editing, and finalization.
Supported by Junta de Andalucia, No. PC-0498-2017 and No. PC-0549-2017.
Conflict-of-interest statement: The authors declare no conflict of interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Carolina Torres, PhD, Assistant Professor, Department of Biochemistry and Molecular Biology III and Immunology, Faculty of Sciences, University of Granada, Avd. de la Investigación n 11, Torre C. Planta 11., Granada 18071, Spain.
Received: February 21, 2021
Peer-review started: February 21, 2021
First decision: May 8, 2021
Revised: May 18, 2021
Accepted: August 27, 2021
Article in press: August 27, 2021
Published online: October 15, 2021

Pancreatic cancer (PC) continues to pose a major clinical challenge. There has been little improvement in patient survival over the past few decades, and it is projected to become the second leading cause of cancer mortality by 2030. The dismal 5-year survival rate of less than 10% after the diagnosis is attributable to the lack of early symptoms, the absence of specific biomarkers for an early diagnosis, and the inadequacy of available chemotherapies. Most patients are diagnosed when the disease has already metastasized and cannot be treated. Cancer interception is vital, actively intervening in the malignization process before the development of a full-blown advanced tumor. An early diagnosis of PC has a dramatic impact on the survival of patients, and improved techniques are urgently needed to detect and evaluate this disease at an early stage. It is difficult to obtain tissue biopsies from the pancreas due to its anatomical position; however, liquid biopsies are readily available and can provide useful information for the diagnosis, prognosis, stratification, and follow-up of patients with PC and for the design of individually tailored treatments. The aim of this review was to provide an update of the latest advances in knowledge on the application of carbohydrates, proteins, cell-free nucleic acids, circulating tumor cells, metabolome compounds, exosomes, and platelets in blood as potential biomarkers for PC, focusing on their clinical relevance and potential for improving patient outcomes.

Keywords: Pancreatic cancer, Biomarkers, Liquid biopsy, Clinical management, Cancer interception, Cancer monitoring

Core Tip: Pancreatic cancer (PC) is still an especially lethal malignancy, with a 5-year survival rate below 10%. Liquid biopsies are a readily-available source of biomarkers to determine the situation of patients. This review summarizes the most recent published findings on the diagnostic, prognostic, and predictive potential for PC of biomarkers identified in liquid biopsies, discussing the strengths, limitations, and drawbacks of their clinical application. There remains a need to validate and verify the clinical value of liquid biopsies for PC in large-scale human trials using appropriate controls.