Shunda Wang,1,* Cuidie Ma,2,* Zhihua Ren,3,* Yufei Zhang,2 Kun Hao,4 Chengxiu Liu,4 Lida Xu,4 Shun He,5 Jianwei Zhang1 

1Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China; 2College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, 100029, People’s Republic of China; 3Department of General Surgery, Qilu Hospital Fo Shandong University, Jinan, 250012, People’s Republic of China; 4Beijing Hotgen Biotech Co., Ltd, Beijing, 102600, People’s Republic of China; 5Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Shun He, Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China, Email heshuns@126.com Jianwei Zhang, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China, Email panchutong@163.com

Introduction: Early diagnosis is crucial for improving the prognosis of patients with gastric cancer (GC). However, the currently used biomarkers for diagnosing GC have limited sensitivity and specificity. This study aimed to develop a novel diagnostic model based on miRNAs from glycosylated extracellular vesicles and evaluate its effectiveness in diagnosing gastric cancer.
Methods: GlyExo-capture technology was used to isolate glycosylated extracellular vesicles from serum samples. The signatures were screened in a discovery cohort of GC patients (n=55) and non-disease controls (n=46) using an integrated process, including high-throughput sequencing technology, screening using a complete bioinformatics algorithm, validation using RT-qPCR, and evaluation by constructing a diagnostic model. The diagnostic model was evaluated in an independent validation cohort (n=139).
Results: We developed a diagnostic model for GC based on five miRNA pairs. This diagnostic model demonstrated high sensitivity, specificity, and stable performance in distinguishing GC patients from non-cancer controls with AUC of 0.930 in the independent validation cohort, particularly in differentiating early-stage GC from benign patients. The markers also showed excellent performance in indicating perineural invasion status and lymph node metastasis in the testing cohort.
Discussion: The model demonstrated high sensitivity and specificity in diagnosing patients with GC, especially in differentiating early-stage GC from benign patients. The five miRNA pairs could also aid in making treatment decisions. Thus, miRNAs derived from glycosylated exosomes are promising biomarkers for cancer diagnosis.

Keywords: biomarker, diagnosis, gastric cancer, extracellular vesicles, microRNAs