Diagnostic and prognostic values of pancreatic juice carbohydrate antigen 19-9 and carcinoembryonic antigen levels in patients with pancreatic cancer

Abstract

BACKGROUND

The estimated 5-year survival rate of pancreatic cancer is 13%, with a median survival of 4 months. Therefore, early detection and personalized treatment are essential. Carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA) help diagnose the disease and predict metastasis and recurrence. Pancreatic juice (PJ) contains tumor-specific proteins released by pancreatic cancer cells, which can be collected during surgical resection or endoscopic retrograde cholangiopancreatography (ERCP). The prognostic significance of CA 19-9 and CEA levels in PJ remains uncertain.

AIM

To hypothesize that CA 19-9 and CEA concentrations in PJ are significantly higher in pancreatic cancer patients than in those with benign conditions, even when serum levels are normal, suggesting potential predictive value for 2-year and 5-year survival outcomes.

METHODS

A prospective cohort study conducted over 10 years involved patients with resectable pancreatic cancer who underwent pancreaticoduodenectomy (Whipple procedure), along with a control group with benign conditions. PJ was collected during the Whipple procedure from the main pancreatic duct after the resection of the pancreatic head and during ERCP in patients with benign hepatobiliary conditions. The samples were analyzed using the “ECLIA” method (Roche Elecsys 1010/2010). Data analysis involved Fisher’s exact test, the Mann-Whitney U test, and the log-rank test.

RESULTS

The study involved 24 patients, of whom 17 (71%) underwent surgery for pancreatic cancer, and 7 (29%) had ERCP. Two-year survival was seen in 8 (47%) patients, and 5-year survival in 5 (29%). Significantly higher levels of PJ CA 19-9 and CEA were found in the operated group. All patients with serum CA 19-9 < 25 U/mL survived at least 2 years after surgery, which was a statistically significant difference (Fisher’s exact test, P = 0.03). Patients with CA 19-9 levels ≥ 25 U/mL had significantly shorter 2-year and 5-year survival than those with CA 19-9 < 25 U/mL (Log-rank test, P = 0.04). There were no significant differences in serum and PJ CEA levels or PJ CA 19-9 concentrations based on 2-year and 5-year survival outcomes.

CONCLUSION

CA 19-9 is a prognostic biomarker that enables a personalized approach to adjuvant therapy. Furthermore, these findings have significant clinical implications for future research. CA 19-9 levels in PJ may help more accurately distinguish pancreatic adenocarcinoma from pancreatitis. Additionally, levels below 25 mL/U PJ CA19-9 suggest a better prognosis and survival, which could be used to enhance patient monitoring during current procedures. Collecting specimens during ERCP can help distinguish pancreatic cancer from pancreatic inflammation, preventing unnecessary surgeries and guiding appropriate interventions.

Keywords: Pancreatic cancer; Tumor markers; Pancreatic juice; Survival; Carbohydrate-antigen 19-9; Carcinoembryonic antigen

Core Tip: Early detection and personalized treatment are crucial for managing pancreatic cancer. Carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA) help diagnose and predict metastases and recurrence. Pancreatic juice (PJ) contains tumor-specific proteins released by pancreatic cancer cells and can be collected during surgical resection or endoscopic retrograde cholangiopancreatography. The prognostic value of CA 19-9 and CEA levels in PJ remains uncertain. CA 19-9 levels in PJ may help more accurately distinguish pancreatic adenocarcinoma from pancreatitis. Additionally, levels below 25 mL/U PJ CA 19-9 indicate a better prognosis and survival, which could help improve patient monitoring during current procedures.