Trogrlić B, Požgain Z, Augustin G, Kovačić B, Hil D, Šerić I, Šikić V. Diagnostic and prognostic values of pancreatic juice carbohydrate antigen 19-9 and carcinoembryonic antigen levels in patients with pancreatic cancer. World J Gastrointest Oncol 2026; 18(5): 119610 [DOI: 10.4251/wjgo.v18.i5.119610]
Corresponding Author of This Article
Goran Augustin, MD, PhD, Consultant Physician-Scientist, Staff Physician, Surgeon, Department of Surgery, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb 10000, Croatia. augustin.goran@gmail.com
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May 15, 2026 (publication date) through May 14, 2026
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World Journal of Gastrointestinal Oncology
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Trogrlić B, Požgain Z, Augustin G, Kovačić B, Hil D, Šerić I, Šikić V. Diagnostic and prognostic values of pancreatic juice carbohydrate antigen 19-9 and carcinoembryonic antigen levels in patients with pancreatic cancer. World J Gastrointest Oncol 2026; 18(5): 119610 [DOI: 10.4251/wjgo.v18.i5.119610]
Bojan Trogrlić, Borna Kovačić, Dejan Hil, Ivan Šerić, Veronika Šikić, Department of Abdominal Surgery, University Hospital Centre Osijek, Osijek 31000, Croatia
Bojan Trogrlić, Zrinka Požgain, Borna Kovačić, Dejan Hil, Veronika Šikić, Faculty of Medicine, J.J. Strossmayer University Osijek, Osijek 31000, Croatia
Zrinka Požgain, Department of Abdominal Surgery, University Hospital Centre, Osijek 31000, Croatia
Goran Augustin, Department of Surgery, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Author contributions: Trogrlić B and Kovačić B designed the research; Trogrlić B, Požgain Z, and Hil D performed the research; Augustin G, Hil D, and Šerić I analyzed the data; Trogrlić B, Augustin G, Požgain Z, and Šikić V wrote the paper. All authors have read and approved the final manuscript.
Institutional review board statement: The study followed the principles of the Declaration of Helsinki. It received approval from the Ethics Committee of University Hospital Centre Osijek in Osijek, Croatia (No. R2:17233-5/2017).
Informed consent statement: All participants signed the informed consent before the intervention.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Corresponding author: Goran Augustin, MD, PhD, Consultant Physician-Scientist, Staff Physician, Surgeon, Department of Surgery, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb 10000, Croatia. augustin.goran@gmail.com
Received: February 3, 2026 Revised: February 7, 2026 Accepted: February 26, 2026 Published online: May 15, 2026 Processing time: 102 Days and 9.8 Hours
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.
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.
Citation: Trogrlić B, Požgain Z, Augustin G, Kovačić B, Hil D, Šerić I, Šikić V. Diagnostic and prognostic values of pancreatic juice carbohydrate antigen 19-9 and carcinoembryonic antigen levels in patients with pancreatic cancer. World J Gastrointest Oncol 2026; 18(5): 119610
Pancreatic cancer is the 7th leading cause of cancer-related death (3% of all malignant diseases) in both sexes. The estimated 5-year survival rate is 13%, with only 15%-20% of cases being resectable. Median survival is about 4 months[1-3]. Late presentation and ineffective therapies contribute to the poor prognosis of advanced disease, making it one of the few cancers where mortality rates have changed very little over the past three decades[4]. Early detection through imaging remains challenging, even when multiple imaging techniques are combined. As a result, most patients are diagnosed at an advanced stage. Another issue is resecting abnormalities that appear benign on histology, which can lead to unnecessary harm. Additionally, due to difficulty in detection and unclear diagnostics, radical surgery is often performed for conditions later confirmed to be benign by histopathology. Given the poor prognosis, further efforts are justified to develop methods for early detection of pancreatic cancer, understand its properties for targeted therapy, and personalize treatment. Structural cellular changes are expected to occur months or years before a lesion appears on imaging. Therefore, biomarkers may help supplement imaging in ruling out malignant disease[2,4].
Tumor markers carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA) are used to predict metastases and recurrence[5]. CA 19-9 is regarded as the most useful prognostic marker in pancreatic cancer. Preoperative CA 19-9 levels were significantly higher in patients with R1 resection compared to those with R0 resection. Additionally, levels were higher in patients with nodal metastases than those without, and postoperative CA 19-9 levels were significantly higher in patients who did not receive adjuvant chemotherapy[6,7]. Serum CEA is the most commonly used tumor marker for gastrointestinal cancers, making it a routine test for screening and prognosis of colorectal cancer. It was originally developed for pancreatic cancer and was used in the 1970s-1980s, prior to CA 19-9[8]. Few studies suggest that pretreatment CEA levels are linked to poorer treatment outcomes, predicting overall and disease-free survival after pancreatic cancer resection and adjuvant chemotherapy[9,10]. According to current literature, preoperative CA 19-9 < 100 U/mL or CEA < 10 ng/mL is associated with significantly longer adjusted median survival and higher 5-year survival rates compared with CA 19-9 ≥ 100 U/mL or CEA ≥ 10 ng/mL[11-15]. The 5-year survival rate was only 3% in patients with CA 19-9 ≥ 100 U/mL and as low as 0.5% in those with CEA ≥ 10 ng/mL, compared to 19% in patients with CA 19-9 < 100 U/mL. This indicates that CA 19-9 < 100 U/mL can serve as both a predictor of pancreatic ductal adenocarcinoma (PDAC) outcomes and a criterion for determining resectability of localized PDAC[12,14,15]. However, neither serum CA 19-9 nor CEA alone can reliably predict prognosis, because patients with negative Lewis’s antigen (Lea-, b-) do not produce CA 19-9, and CEA is not a specific biomarker for pancreatic cancer. Therefore, they are typically used as supplementary indicators to predict PDAC prognosis[10-15].
Pancreatic cancer is a deadly disease often diagnosed at an advanced stage. Due to difficulties in detection and unclear diagnostics, aggressive surgical procedures are frequently performed for conditions that are later confirmed to be benign through histopathology. Therefore, new methods are needed to detect pancreatic cancer early. One such method involves analyzing pancreatic juice (PJ). PJ is a medium specific to the pancreas because of the continuous flushing of the pancreatic ductal system, which keeps it in constant contact with the ductal epithelium from which the cancer develops. Analyzing PJ could thus serve as a potential early diagnostic method for pancreatic cancer[16]. PJ is a rich source of tumor-specific proteins released from pancreatic cancer cells through direct contact with the ductal epithelial lining, where PDAC develops. It can be collected during surgical resection or endoscopic retrograde cholangiopancreatography (ERCP). The potential of PJ CA 19-9 and CEA levels as prognostic biomarkers warrants further study. Research has shown that the proteomes of PJ from patients without pancreatic disease differ significantly from those of patients with pancreatic cancer[11-13].
We suggest that PJ CA 19-9 and CEA levels in pancreatic cancer patients are notably higher than those in patients with benign conditions, even if serum levels fall within the normal range. We anticipate that CA 19-9 and CEA levels in both serum and PJ will have high predictive value for 2-year and 5-year survival rates in pancreatic cancer patients.
MATERIALS AND METHODS
A prospective cohort study was conducted among patients admitted to the Department of Abdominal Surgery at the University Hospital Centre Osijek over a 10-year period (2014-2024). The study included patients operated on for pancreatic cancer and those with benign hepatobiliary conditions, all with choledocholithiasis, forming the control group. Inclusion criteria required cancer resectability, meaning resection of the pancreatic head to access the pancreatic duct for juice specimen collection. All patients underwent the same diagnostic protocol before surgery, in accordance with clear surgical criteria. Each patient had a computed tomography (CT) scan of the chest and abdomen, and all had histopathologically confirmed PDAC. Patients with definitive diagnostic criteria for radical surgery were evaluated based on CT findings. Tumor resectability was considered if there was no distant tumor spread and no invasion of major arteries and veins (portal vein, superior mesenteric vein, and artery). Diagnostic sampling was performed via needle biopsy or ERCP. All patients underwent radical pancreatic head resection, specifically the Whipple procedure. Patients with jaundice or elevated bilirubin levels before surgery were treated with a biliary stent or transhepatic biliary drainage. The control group, undergoing ERCP for benign disease, had PJ collected during the procedure. The timing and conditions of PJ collection were the same for all participants: Specimens were collected during surgery after pancreatic head resection for the operated group and during ERCP after pancreatic duct cannulation for the control group. Patients with choledocholithiasis do not represent a ‘healthy’ pancreas; however, this group was used to best describe the study results, and these results cannot be generalized. A 1 mL sample of PJ was sent to the laboratory immediately. Concurrently, serum samples for CA 19-9 and CEA concentrations were obtained. All control group patients had normal laboratory findings, with no signs of inflammation in the pancreas or biliary system, and no clinical complaints. Immunohistochemistry with electroluminescence was performed on the Roche Elecsys 1010/2010 immunochemical analyzer. Sample collection did not cause additional pain, nor did it affect the duration, course, or outcome of the operation, or influence results, recovery, or further treatment. All patients signed informed consent and were informed about the procedure, with the option to decline sample collection.
The 2-year and 5-year survival rates for patients were analyzed using the hospital database, which included records of recent oncology assessments. In the few cases where data were missing, the patient was personally contacted to confirm the results. The study followed the principles of the Declaration of Helsinki. It received approval from the Ethics Committee of University Hospital Centre Osijek in Osijek, Croatia (No. R2:17233-5/2017). All participants gave informed consent.
Statistical analysis
Categorical data were reported as absolute and relative frequencies. Differences in categorical variables were analyzed using Fisher’s exact test. Because of the small sample size, continuous data were summarized with medians and interquartile ranges. Differences in continuous variables were evaluated with the Mann-Whitney U test. Kaplan-Meier survival curves were compared using the log-rank test. All P-values were two-tailed, with a significance level set at α = 0.05. Statistical analysis was conducted using MedCalc® Statistical Software version 23.0.6 (MedCalc Software Ltd, Ostend, Belgium; https://www.medcalc.org; 2024).
RESULTS
The study included 24 patients, of whom 17 (71%) had surgery for pancreatic cancer, and 7 (29%) with benign hepatobiliary conditions (choledocholithiasis) underwent ERCP, forming the control group. There were no significant gender differences between the operated patients and the control group; 19 (79%) were men, and 5 (21%) were women. The median age of the operated patients was 68 years (range 66-73). The follow-up period was 59 months (range 37-78). Two-year survival was achieved in 8 (47%) patients, and 5-year survival in 5 (29%) (Table 1).
Table 1 Characteristics of operated and control patients, n (%).
The operated group had significantly higher PJ CA 19-9 levels compared to the control group (median 10108 vs 349) (Mann-Whitney U test, P = 0.01) (Table 2). CEA PJ concentration values were significantly higher in the operated group (median 113.8 vs 3.59) (Mann-Whitney U test, P < 0.001) (Table 3). Spearman’s correlation coefficient was used in the operated group to evaluate the relationship between patient age, serum tumor markers, and CEA and CA 19-9 PJ concentrations. There was no significant association between age and the tumor markers, nor were there any significant correlations among the tumor markers themselves (Table 4).
Table 2 Differences in the carbohydrate antigen 19-9 pancreatic juice concentration values (U/mL).
All patients with serum CA 19-9 < 25 U/mL were alive 2 years after surgery, and we found a significant difference (Fisher’s exact test, P = 0.03). Patients with CA 19-9 levels ≥ 25 U/mL had significantly shorter survival at 2 years and 5 years 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 in PJ CA 19-9 concentration across 2-year and 5-year survival outcomes (Tables 5 and 6).
Table 5 Influence of tumor marker values (carbohydrate antigen 19-9 serum U/mL, carbohydrate antigen 19-9 pancreatic juice U/mL, carcinoembryonic antigen serum ng/mL, carcinoembryonic antigen pancreatic juice ng/mL) on 2-year survival.
Regarding serum levels of CA 19-9 and CEA, a significant difference was observed only in the 2-year outcome for CA 19-9 values (Fisher’s exact test, P = 0.03). However, no significant differences were found in the distribution of operated patients by 2-year and 5-year outcomes for CEA values (Table 7).
Table 7 Differences in the distribution of operated patients by carbohydrate antigen 19-9 and carcinoembryonic antigen values concerning 2-year and 5-year survival, n (%).
Two-year survival was 47%, 5-year survival was 29%, and median survival was 17 months. Median survival is the point at which the probability of survival drops to 50% or below. It cannot be calculated if the survival curve does not fall to ≤ 0.5. Median survival time and its 95% confidence interval were calculated using the Brookmeyer & Crowley method (1982). No significant difference in 2-year or 5-year survival was observed by CEA level, with a median survival of 16 months in patients with CEA ≥ 2.5 ng/mL. Patients with CA 19-9 values ≥ 25 U/mL had significantly shorter 2- and 5-year survival than those with CA 19-9 < 25 U/mL (Log-rank test, P = 0.04). Survival data are also presented in Kaplan-Meier curves (Figures 1 and 2).
Figure 1 Kaplan-Meier 2- and 5-year survival curve after pancreaticoduodenectomy for pancreatic cancer.
A: Kaplan-Meier 2-year survival curve after pancreaticoduodenectomy for pancreatic cancer; B: Kaplan-Meier 5-year survival curve after pancreaticoduodenectomy for pancreatic cancer.
Figure 2 Kaplan-Meier 2- and 5-year survival curve considering carbohydrate antigen 19-9 and carcinoembryonic antigen values after pancreaticoduodenectomy for pancreatic cancer.
A: Kaplan-Meier 2- and 5-year survival curve considering carbohydrate antigen 19-9 values after pancreaticoduodenectomy for pancreatic cancer; B: Kaplan-Meier 2- and 5-year survival curve considering carcinoembryonic antigen values after pancreaticoduodenectomy for pancreatic cancer. CA 19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen.
DISCUSSION
In most solid organ cancers, significant progress has been made through earlier diagnosis and targeted therapies. However, PDAC mortality rates are actually increasing, and it is projected that by 2030, pancreatic cancer will surpass breast, prostate, and colorectal cancers to become the second leading cause of cancer-related death, with only lung cancer ranked higher. Only 10%-20% are diagnosed at an early stage suitable for surgical resection, yet surgery remains the only potentially curative treatment for PDAC[14,15,17-20].
CA 19-9 plays a vital role in pancreatic cancer detection. However, false-negative results in sialyl Lewis-negative individuals and false-positive results in obstructive jaundice limit its widespread use in serum testing. This also impacts its role as a prognostic marker due to uncertainties about the ideal cutoff value[6,21,22]. Our results showed significantly higher levels of PJ CA 19-9 and CEA in the pancreatic carcinoma group compared to the benign condition group (Tables 2 and 3). This suggests the potential for routine sampling during ERCP to differentiate benign conditions from tumors. The samples collected during ERCP in the control group were obtained directly from the ampulla, providing purer PJ, since duodenal collections can contain lower marker concentrations due to mixing with duodenal contents[23-28]. This sample might be comparable to those obtained during pancreaticoduodenectomy and should not show lower values. A review of the literature reveals no similar studies to date that include PJ samples from patients with benign conditions for comparison with pancreatic cancer cases. Therefore, we consider our findings novel and a contribution to the evolving field of pancreatic cancer diagnosis and treatment. Accurate diagnosis and staging of pancreatic cancer are often complex and challenging, so routine collection of PJ samples during ERCP could sometimes assist in diagnosis and prevent unnecessary surgeries.
Studies on pancreatic cancer patient survival report a median duration of 13.6 months (31.7 ± 3.5 months). The 5-year survival rate was 14.6%, including five patients (4.1%) who survived more than 10 years[28-30]. Another study found a median overall survival of 9.3 months. The overall 1-, 3-, and 5-year survival rates were 37.8%, 15.1%, and 10.5%, respectively. Independent prognostic factors for patients with pancreatic cancer included baseline CA 19-9 levels, neutrophil-lymphocyte ratio, operative procedure, lymph node metastasis, number of distant organ metastases, and postoperative adjuvant chemotherapy[28-31]. Considering these factors, lymphovascular invasion, lymph node metastasis, vascular resection, maximum tumor diameter > 2 cm, poor differentiation, peripancreatic fat invasion, absence of postoperative chemotherapy, and advanced TNM stage were associated with 2-year survival. Additionally, lymph node metastasis, degree of differentiation, and TNM stage influenced long-term survival[29]. Recent studies on resectable PDAC show that patients with preoperative CA 19-9 < 100 U/mL or CEA < 10 ng/mL had significantly longer adjusted median survival times and higher 5-year survival rates compared to those with CA 19-9 ≥ 100 U/mL or CEA ≥ 10 ng/mL[12-15,17-21]. The 5-year survival rate was only 3% in patients with CA 19-9 ≥ 100 U/mL and as low as 0.5% in patients with CEA ≥ 10 ng/mL, compared to 19% in patients with CA 19-9 < 100 U/mL. This suggests that CA 19-9 < 100 U/mL can serve as both a predictor of PDAC outcomes and a criterion for determining resectability of localized PDAC[12,14,15]. These results are likely due to the close associations of CA 19-9 and CEA with cancer cell proliferation and metastasis. However, neither serum CA 19-9 nor CEA can be used alone to predict prognosis because patients with negative Lewis’s antigen (Lea-, b-) do not produce CA 19-9, and CEA is not a specific biomarker for pancreatic cancer. Therefore, they are usually used as supplementary indices to predict PDAC prognosis[20-24,32]. Data from the National Cancer Database for 1998 to 2002 showed that 3.9% of patients with resected PDAC survived 10 years or more[13,16,31,33-35]. In our results, 8 (47%) patients survived 2 years, and 5 (29%) survived 5 years (Tables 2 and 8), which aligns with data from recent studies. No significant differences were observed in serum CEA levels in PJ, nor in PJ CA 19-9, with respect to 2-year and 5-year survival (Tables 6 and 7). A significant difference was observed only in the 2-year CA 19-9 serum concentration outcome (Table 9), confirming its role as a predictor of pancreatic cancer survival. Patients with CA 19-9 values ≥ 25 U/mL had significantly shorter 2-year and 5-year survival compared to those with CA 19-9 < 25 U/mL (Table 8). Studies assessing diagnostic sensitivity and specificity often use 100 U/mL as a threshold to differentiate PDAC from benign conditions. Higher cut-offs generally boost specificity but reduce sensitivity. Using a higher threshold increases confidence that elevated CA 19-9 indicates substantial tumor burden rather than benign or non-tumor-related elevations (e.g., cholestasis, inflammation). Conversely, a lower cut-off improves sensitivity, making it more likely to detect patients with smaller tumors or early disease who might otherwise fall below the higher threshold. This is particularly important when CA 19-9 is used alongside imaging or other diagnostic methods, rather than as a standalone test. In populations with elevated baseline levels due to benign conditions, a lower threshold may also identify clinically relevant elevations that would be missed at ≥ 100 U/mL. Additionally, a lower threshold may perform better in combined models that incorporate CA 19-9 with other predictors (e.g., imaging, PJ markers). Using a cut-off of ≥ 25 U/mL can be justified when screening or triaging patients for further evaluation. The clinical pathway accepts some false positives in exchange for fewer false negatives. Combining diagnostic tests (e.g., imaging) helps mitigate the impact of lower specificity. Higher thresholds, like ≥ 100 U/mL, are traditionally more reliable for correlating CA 19-9 levels with tumor burden and survival outcomes. The rationale for using a lower cut-off may lack specificity for advanced disease, potentially limiting prognostic accuracy. Still, it aligns with the observation that this CA 19-9 threshold predicts diagnosis effectively but does not independently predict survival. Using CA 19-9 ≥ 25 U/mL is clinically relevant when the aim is to maximize sensitivity and incorporate PJ CA 19-9 into a complex diagnostic algorithm.
PJ CEA demonstrated excellent diagnostic discrimination between malignant and benign conditions, but it failed to predict survival because the biological and clinical factors influencing prognosis in PDAC are fundamentally different from those enabling local tumor detection. PJ CEA mainly reflects local ductal secretion rather than systemic tumor burden. CEA is secreted directly by malignant ductal epithelial cells into the pancreatic duct, resulting in significantly elevated levels in PJ even in relatively small or early-stage tumors. This explains the high diagnostic contrast observed between cancer and benign disease. However, survival in PDAC is primarily affected by factors such as occult micrometastatic spread, lymph node involvement, vascular invasion, tumor biology, and response to adjuvant therapy. Unlike CA 19-9, which more closely correlates with tumor burden, nodal metastasis, and residual disease, CEA expression is heterogeneous and not directly linked to proliferation rate, invasiveness, or treatment resistance in PDAC. In this study, PJ CEA levels showed no meaningful association with 2-year or 5-year survival, confirming that CEA secretion into the PJ is not a marker of aggressive tumor biology. Conversely, CA 19-9 demonstrated prognostic significance consistent with extensive research connecting it to survival, recurrence, and treatment response. Therefore, PJ CEA appears best suited as a diagnostic tool to distinguish malignant from inflammatory or benign pancreatic conditions during ERCP, rather than as a predictor of survival. PJ CEA does not predict survival because it indicates local tumor presence rather than systemic disease aggressiveness. Its strong diagnostic contrast highlights its potential for early detection and differential diagnosis. Nonetheless, its lack of prognostic value underscores the importance of systemic markers and clinicopathological variables when estimating survival in PDAC. The results of this study support the development of potential biomarkers from PJ as a readily available medium for patient diagnostic processing. One potential approach is the use of imaging mass spectrometry, which could enable more precise identification of biomolecules that may serve as future tumor biomarkers for PDAC[36].
Our study is notably limited by a small sample size. The limited number of participants reduces statistical power to detect modest survival differences and increases susceptibility to variability, especially given the broad interquartile ranges of PJ CEA values. This variability weakens any potential prognostic signal, even when diagnostic separation is strong. The limited subgroup sizes also constrain the survival analyses, which are only descriptive and hypothesis-generating. This study offers insight into the value of PJ as a relatively accessible medium that may enable the development of new, more precise biomarkers and provide insight into PDAC tumor heterogeneity.
CONCLUSION
The study confirmed the hypothesis and identified CA 19-9 as a prognostic biomarker that supports a personalized approach and tailored adjuvant therapy. Additionally, these findings have important clinical implications for planning future research, collecting specimens during ERCP, distinguishing pancreatic cancer from pancreatic inflammation, and avoiding unnecessary surgeries or ensuring appropriate treatment.
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