The Levels of Tumor Markers in Pancreatic Neuroendocrine Carcinoma and Their Values in Differentiation Between Pancreatic Neuroendocrine Carcinoma and Pancreatic Ductal Adenocarcinoma

Abstract

Objectives The levels of tumor markers in pancreatic neuroendocrine carcinoma (PNEC) are unknown, and imaging findings of PNEC and pancreatic ductal adenocarcinoma (PDAC) have overlaps. In this study, we show the tumor markers in PNEC and evaluate their values for distinguishing PNEC from PDAC. Methods Thirty-three cases of PDAC and 21 cases of PNEC were retrospectively evaluated. The demographic information and clinical data were reviewed. Results Pancreatic neuroendocrine carcinoma was usually misdiagnosed (57.1%) as PDAC based on imaging findings. Abnormal carbohydrate antigen (CA) 19-9, carcinoembryonic antigen (CEA), and α-fetoprotein (AFP) were observed in 19.0% to 28.6% of PNECs. Abnormal CA 19-9 and CA 125 levels were more common in PDAC than in PNEC (P < 0.05). Higher level of AFP was more common in PNEC than in PDAC (33.3% vs 3.0%, P < 0.05). The cutoff value of CA 19-9 for detecting PNEC was calculated as 38.5 U/mL or less with 0.788 sensitivity and 0.800 specificity. Carbohydrate antigen 19-9 (odds ratio [OR], 22.9; 95% confidence interval [CI], 2.94–179.3), AFP (OR, 0.08; 95% CI, 0.012–0.564), and CA 125 (OR, 17.4; 95% CI, 1.13–267.3) were predictors in differentiating PDAC from PNEC. Conclusions Carbohydrate antigen 19-9, AFP, and CA 125 have potential for distinguishing hypovascularized PNEC from PDAC.

Increased carbohydrate antigen 19‐9 expression in a thymic neuroendocrine tumor

“…CA19‐9 is a diagnostic tumor marker to differentiate between pancreatic adenocarcinoma and NETs 6,7 . Several studies of CA19‐9 in pancreatic NET patients have been reported.…”

“…CA19‐9 is a diagnostic tumor marker to differentiate between pancreatic adenocarcinoma and NETs. 6 , 7 Several studies of CA19‐9 in pancreatic NET patients have been reported. Luo et al 3 reported that CA19‐9 > 16 U/ml was significantly associated with a higher proportion of patients at advanced stages and was an adverse prognostic factor for overall survival.…”

“…Serum level of the tumor‐associated carbohydrate biomarker, carbohydrate antigen 19‐9 (CA19‐9), is used for diagnosis and post‐treatment monitoring in patients with pancreatic and gastrointestinal malignancies, with median sensitivity and specificity of 79% (70%–90%) and 82% (68%–91%), respectively, for diagnosis of pancreatic cancer 1,2 . Several studies have indicated elevated serum CA19‐9 in pancreatic neuroendocrine tumors (NETs) 3–7 . CA19‐9 is important for differentiating between pancreatic adenocarcinomas and pancreatic NETs, 6,7 but little is known regarding CA19‐9 in other types of NET.…”

“… 1 , 2 Several studies have indicated elevated serum CA19‐9 in pancreatic neuroendocrine tumors (NETs). 3 , 4 , 5 , 6 , 7 CA19‐9 is important for differentiating between pancreatic adenocarcinomas and pancreatic NETs, 6 , 7 but little is known regarding CA19‐9 in other types of NET.…”

Molecular drivers and cells of origin in pancreatic ductal adenocarcinoma and pancreatic neuroendocrine carcinoma

“…CA199 and CEA are sensitive and specific markers for PDAC diagnosis and prognosis. Abnormal CA199 and CEA levels have been found in Pan-NEC, while serum CA199, CEA, and AFP levels above the upper limit have been observed in 23.8%, 28.6% and 19.0% of PanNEC cases, respectively [69]. Abnormal CA199 and CA125 levels are more commonly found in PDAC than in PanNEC.…”