ZIP4 is a Novel Diagnostic and Prognostic Marker in Human Pancreatic Cancer: A Systemic Comparison Between EUS-FNA and Surgical Specimens
C. Xu, M.B. Wallace, J. Yang, L. Jiang, Q. Zhai, Y. Zhang, C. Hong, Y. Chen, T.S. Frank, J.A. Stauffer, H.J. Asbun, M. Raimondo, T.A. Woodward, Z. Li, S. Guha, L. Zheng and M. Li
Affiliation: Vivian L. Smith Department of Neurosurgery, the University of Texas Medical School at Houston, 6431 Fannin Street, MSE R131, Houston, TX 77030, USA.
Aberrant expression of a zinc transporter ZIP4 in pancreatic ductal adenocarcinoma (PDAC) has
been shown to contribute to tumor progression and is a potential target for individualized therapy. The overall
objective of this study was to determine whether ZIP4 could serve as a novel diagnostic and prognostic marker
in human PDAC, and if it can be assessed by minimally invasive sampling using endoscopic ultrasound guided
fine needle aspiration (EUS-FNA). Immunohistochemistry was performed to compare ZIP4 expression in the
PDAC samples obtained from EUS-FNA and matched surgical tumors (parallel control). Samples were
reported by sensitivity, specificity, and predictive values, all with 95% confidence intervals (CI). A total of 23
cases with both FNA and surgical specimens were evaluated. We found that ZIP4 was significantly overexpressed
in tumor cells from both sets of samples. The sensitivity, specificity, positive predictive value (PPV),
and negative predictive value (NPV) of ZIP4 for the diagnosis of PDAC were 72.9%, 72.5%, 76.1%, and 69.0%
in EUS-FNA samples, and were 97.9%, 65.4%, 83.9%, and 94.4% in surgical specimens, respectively. The
association between the positive rate of ZIP4 expression in FNA and surgical samples is statistically significant
(P=0.0216). Both the intensity and percentage of ZIP4 positive cells from the surgical samples correlated
significantly with tumor stage (P=0.0025 and P=0.0002). ZIP4 intensity level in FNA samples was significantly
associated with tumor differentiation and patient survival. These results indicate that EUS-FNA is capable of
non-operative detection of ZIP4, thus offering the potential to direct pre-operative detection and targeted
therapy of PDAC.
Keywords: Pancreatic cancer, prediction, prognosis, survival, ZIP4.
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