Confounding effect of obstructive jaundice in the interpretation of proteomic plasma profiling data for pancreatic cancer.

It is well established that variation in sampling, processing and storage protocols can alter the levels of potential biomarkers in serum and plasma. Here, using pancreatic cancer as an example, we demonstrate that consideration of clinical parameters related to the patient's illness is equally important when seeking cancer-specific biomarkers. Bile duct-obstruction is a feature of pancreatic disease that can cause jaundice. Comparing patients with pancreatic cancer, chronic pancreatitis or biliary duct obstruction, we observed that the plasma levels of apolipoprotein A1, transthyretin, and apolipoprotein E, when examined in isolation, were each associated with pancreatic cancer. However, when the effect of bile duct obstruction was considered, only transthyretin levels were independently associated with cancer likelihood. Our results demonstrate the importance of accounting for disease-related confounding factors when analyzing data for the detection of cancer biomarkers.