Skip to main content
  • Poster presentation
  • Open access
  • Published:

Metabolic biomarkers for the differential diagnosis of pancreatic ductal adenocarcinoma vs. chronic pancreatitis


The incidence of chronic pancreatitis (CP) varies between 4 and 23/100.000 in different populations and a tenfold higher prevalence. Current diagnostic tests such as transabdominal ultrasound and CA 19-9 can distinguish between pancreatic cancer (PDAC) and chronic pancreatitis (CP) in only about two thirds of patients. CA19-9 has been reported to discriminate between pancreatic cancer patients and healthy controls with a sensitivity of 0.80 (95 % CI 0.787-0.83) and a specificity of 0.80 (95 % CI 0.78-0.82). Therefore more sensitive biomarkers for the early detection of pancreatic cancer would be urgently needed. Our aim was to identify a panel of plasma metabolite biomarkers for this diagnostic purpose.

Materials and methods

For a case-control study, 914 subjects were retrospectively recruited from three tertiary referral centers with either pancreatic cancer (n=271), chronic pancreatitis (n=282), liver cirrhosis (n=100), or healthy as well as non-pancreatic disease controls (n=261). An initial exploratory study (n=201) was followed by a two-center identification study (n=474; training set) and a third validation test set (n=239). Metabolomic profiles of plasma and serum samples were generated using the comprehensive metabolome platform including lipidomics ((MxP® Broad Profiling, MxP® Steroids, MxP® - gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) ) identifying 477 metabolites.


A consistent multimarker 10-metabolite panel (including sphingomyelin and ceramide) was identified by the Elastic Net algorithm providing an area under the curve (AUC) of up to 0.96 [95% CI 0.93-0.98] (pancreatic cancer vs. chronic pancreatitis). With a fixed sensitivity of 88% and an estimated incidence of 1.95 for pancreatic cancer a test specificity of 93.8% [95% CI84-98%] for the training set and of 91.3% [95% CI 76-94%] for the validation (test) set was reached with a negative predictive value (NPV) of 99.75% [95% CI 99.7-99.8%]. Pancreatic cancer can not only be detected but also distinguished from chronic pancreatitis when still in a resectable (i.e. early) stage.


These results indicate that a plasma metabolite biomarker panel including important metabolites identified by the lipidomics platform can be used to accurately distinguish between pancreatic cancer and chronic pancreatitis. Sphingolipids are characterized by the presence of a particular aliphatic amino alcohol, sphingosine. Cleavage of sphingomyelins by sphingomyelinase generates ceramide, which promotes apoptosis, cell cycle arrest and cellular senescence. It also permits the development of a promising diagnostic plasma biomarker assay for the detection pancreatic cancer in high risk cohorts.

Author information

Authors and Affiliations


Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit

The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mayerle, J., Kalthoff, H., Reszka, R.C. et al. Metabolic biomarkers for the differential diagnosis of pancreatic ductal adenocarcinoma vs. chronic pancreatitis. Cancer Metab 2 (Suppl 1), P60 (2014).

Download citation

  • Published:

  • DOI: