Trypsinogen activation peptide (TAP) expression in gallbladder bile identifies bilio-pancreatic carcinoma

BACKGROUND: The prognosis of bilio-pancreatic cancer (pancreas, bile duct and gallbladder) is poor due to the fact of late diagnosis. The only curative treatment for such tumors is surgery. The 5-year survival rate is still below 5% and less than one-third of patients suffering from such carcinomas are resectable at the time of diagnosis. Although specific tumor markers do exist, to date there is no screening marker for these diseases.

MATERIALS AND METHODS: Gallbladder bile of 44 consecutive cholecystectomized patients were prospectively analyzed for TAP concentrations. Group one (n = 14) consisted of the patients suffering from malignancies of the bilio-pancreatic system, group 2 (n = 22) comprised patients suffering from benign biliar or pancreatic diseases and group 3 (n = 6) included patients suffering from gastrointestinal carcinoma outside the bilio-pancreatic system with no affection of the bilio-pancreatic system.

RESULTS: The median TAP gallbladder bile concentration in malignant disease of the bilio-pancreatic system was 1328.00 nmol/l (range: 83.69-5133.00). Benign bilio-pancreatic disease revealed a median TAP bile concentration of 2.02 nmol/l equaling the concentration of patients suffering from other gastrointestinal carcinomas with a median of 2.00 nmol/l. In the control groups (2 + 3) there was a significant difference for TAP bile concentrations with an increase in the case of acute inflammation.

CONCLUSION: Gallbladder bile TAP concentration discriminates between benign and malignant lesions of the bilio-pancreatic system. In the case of benign disease there is a significantly higher TAP concentration in the case of acute inflammation.