Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer

Goonetilleke, Kolitha; Siriwardena, Ajith K.

doi:10.1016/j.ejso.2006.10.004

Cited by 726 publications

(547 citation statements)

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“…More recently, Goonetilleke et al analyzed the utility of CA 19-9 serum levels (37-40 U/ml) to diagnose pancreatic cancer among 2,283 symptomatic patients reported in 26 case-series. [14] In this report, the sensitivity and specificity of an elevated serum CA 19-9 level was 79% and 82% with a PPV and NPV of 72% and 81% respectively. Overall, an elevated serum CA 19-9 level has a sensitivity of 79-81% and a specificity of 82-90% for diagnosing pancreatic cancer in symptomatic patients.…”

Section: Ca 19-9: Introductionmentioning

confidence: 50%

“…Despite multiple clinical applications for CA 19-9 serum levels in pancreatic cancer patients, the diagnostic utility of CA 19-9 is often limited due to a low or modest sensitivity (79-81%) in symptomatic patients [12,14,15]. Moreover, a very low PPV (0.9%) makes CA 19-9 serum levels a suboptimal test to screen asymptomatic populations [16][17][18].…”

Section: Limitations Of Ca 19-9 Serum Levels As a Pancreatic Cancer Bmentioning

confidence: 99%

“…Moreover, a very low PPV (0.9%) makes CA 19-9 serum levels a suboptimal test to screen asymptomatic populations [16][17][18]. Even among individuals at higher risk of pancreatic cancer (hereditary pancreatitis, family history of pancreatic cancer, Peutz-Jeghers syndrome), CA 19-9 serum levels fail to identify early/small tumors or precancerous lesions in 10-15% of patients [68] and is elevated in only 80-85% of pancreatic cancer patients [12,14,20]. As noted earlier, CA 19-9 serum levels may be elevated in a variety of nonpancreatic neoplastic conditions resulting in a high false positive rate (10-30%).…”

Section: Limitations Of Ca 19-9 Serum Levels As a Pancreatic Cancer Bmentioning

confidence: 99%

“…Le (α-β-) phenotypes occur in 5-10% of population which lack the enzyme 1,4-fucosyl transferase required for antigen epitope production, and as such limits the use of CA 19-9 as a universally applicable biomarker [12][13][14][15].…”

Section: Ca 19-9: Introductionmentioning

confidence: 99%

“…Two previous reviews published 20 and 7 years ago have attempted to summarize the diagnostic utility of serum CA 19-9 levels in pancreatic cancer patients [14,20]. Steinberg analyzed the value of CA 19-9 serum levels (37-40 U/ml) in 24 case series involving 1,040 patients with symptomatic pancreatic cancer and reported a median sensitivity and specificity of 81% and 90% respectively.…”

Section: Ca 19-9: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Serum CA 19-9 as a Biomarker for Pancreatic Cancer—A Comprehensive Review

Ballehaninna

Chamberlain

2011

Indian J Surg Oncol

210

161

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Section: Ca 19-9: Introductionmentioning

confidence: 50%

Section: Limitations Of Ca 19-9 Serum Levels As a Pancreatic Cancer Bmentioning

confidence: 99%

Section: Limitations Of Ca 19-9 Serum Levels As a Pancreatic Cancer Bmentioning

confidence: 99%

Section: Ca 19-9: Introductionmentioning

confidence: 99%

Section: Ca 19-9: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Serum CA 19-9 as a Biomarker for Pancreatic Cancer—A Comprehensive Review

Ballehaninna

Chamberlain

2011

Indian J Surg Oncol

210

161

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Serum Tumor Markers and Outcomes in Patients With Appendiceal Adenocarcinoma

Yousef,

Zeineddine

et al. 2024

JAMA Netw Open

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ImportanceSerum tumor markers carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and cancer antigen 125 (CA125) have been useful in the management of gastrointestinal and gynecological cancers; however, there is limited information regarding their utility in patients with appendiceal adenocarcinoma.ObjectiveTo assess the association of serum tumor markers (CEA, CA19-9, and CA125) with clinical outcomes and pathologic and molecular features in patients with appendiceal adenocarcinoma.Design, Setting, and ParticipantsThis is a retrospective cohort study at a single tertiary care comprehensive cancer center. The median (IQR) follow-up time was 52 (21-101) months. Software was used to query the MD Anderson internal patient database to identify patients with a diagnosis of appendiceal adenocarcinoma and at least 1 tumor marker measured at MD Anderson between March 2016 and May 2023. Data were analyzed from January to December 2023.Main Outcomes and MeasuresAssociation of serum tumor markers with survival in patients with appendiceal adenocarcinoma. Cox proportional hazards regression analyses were also performed to assess associations between clinical factors (serum tumor marker levels, demographics, and patient and disease characteristics) and patient outcomes (overall survival).ResultsA total of 1338 patients with appendiceal adenocarcinoma were included, with a median (range) age at diagnosis of 56.5 (22.3-89.6) years. The majority of the patients had metastatic disease (1080 patients [80.7%]). CEA was elevated in 742 of the patients tested (56%), while CA19-9 and CA125 were elevated in 381 patients (34%) and 312 patients (27%), respectively. Individually, elevation of CEA, CA19-9, or CA125 were associated with worse 5-year survival; elevated vs normal was 81% vs 95% for CEA (hazard ratio [HR], 4.0; 95% CI, 2.9-5.6), 84% vs 92% for CA19-9 (HR, 2.2; 95% CI, 1.4-3.4), and 69% vs 93% for CA125 (HR, 4.6; 95% CI, 2.7-7.8) (P &lt; .001 for all). Quantitative evaluation of tumor markers was associated with outcomes. Patients with highly elevated (top 10th percentile) CEA, CA19-9, or CA125 had markedly worse survival, with 5-year survival rates of 59% for CEA (HR, 9.8; 95% CI, 5.3-18.0), 64% for CA19-9 (HR, 6.0; 95% CI, 3.0-11.7), and 57% for CA125 (HR, 7.6; 95% CI, 3.5-16.5) (P &lt; .001 for all). Although metastatic tumors had higher levels of all tumor markers, when restricting survival analysis to 1080 patients with metastatic disease, elevated CEA, CA19-9, or CA125 were all still associated worse survival (HR for CEA, 3.4; 95% CI, 2.5-4.8; P &lt; .001; HR for CA19-9, 1.8; 95% CI, 1.2-2.7; P = .002; and HR for CA125, 3.9; 95% CI, 2.4-6.4; P &lt; .001). Interestingly, tumor grade was not associated with CEA or CA19-9 level, while CA-125 was slightly higher in high-grade tumors relative to low-grade tumors (mean value, 18.3 vs 15.0; difference, 3.3; 95% CI, 0.9-3.7; P &lt; .001). Multivariable analysis identified an incremental increase in the risk of death with an increase in the number of elevated tumor markers, with an 11-fold increased risk of death in patients with all 3 tumor markers elevated relative to those with none elevated. Somatic mutations in KRAS and GNAS were associated with significantly higher levels of CEA and CA19-9.Conclusions and RelevanceIn this retrospective study of serum tumor markers in patients with appendiceal adenocarcinoma, CEA, CA19-9, and CA125 were associated with overall survival in appendiceal adenocarcinoma. Given their value, all 3 biomarkers should be included in the initial workup of patients with a diagnosis of appendiceal adenocarcinoma.

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Carbohydrates as Unique Structures for Disease Diagnosis

Rittenhouse-Olson

2008

Carbohydrate‐Based Vaccines and Immunotherapies

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Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer

Cited by 726 publications

References 41 publications

Serum CA 19-9 as a Biomarker for Pancreatic Cancer—A Comprehensive Review

Serum CA 19-9 as a Biomarker for Pancreatic Cancer—A Comprehensive Review

Serum Tumor Markers and Outcomes in Patients With Appendiceal Adenocarcinoma

Carbohydrates as Unique Structures for Disease Diagnosis

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