Expression of various sialylated carbohydrate antigens in malignant and nonmalignant pancreatic tissues.

The expression of six sialylated carbohydrate antigens (CA19-9, CA-50, SLEX, SLX, DU-PAN-2, ST-439) was examined in malignant and nonmalignant pancreatic tissues using an immunohistochemical method to elucidate the characteristics of these carbohydrate antigens as tumor markers. All carbohydrate antigens except for sialyl SSEA-1 (SLX, 52.4%) were expressed in more than 80% of the pancreatic cancer. CA19-9 and CA-50, belonging to type I blood group antigens, and DU-PAN-2 and ST-439 were localized predominantly in the cytoplasm of cancer cells, while sialyl Lex (SLEX) and SLX, belonging to type II blood group antigens, were stained mainly on the apical membranes of malignant glands. Although type I antigens were expressed in most nonmalignant pancreatic tissues, the type II antigens and ST-439 were absent in almost all of the normal tissues and faintly expressed in few chronic pancreatitis tissues, suggesting the high tumor specificity of these antigens. Each antigen was expressed on the apical surface of ducts in normal pancreas. However, in about 30% of chronic pancreatitis cases, type I antigens and DU-PAN-2 were observed in the cytoplasm of ductal cells. All patients showing stromal stain, possibly caused by loss of antigen polar expression and shedding into the surrounding stroma adjacent to malignant glands, revealed high levels of serum antigen. This finding suggests that the stromal appearance of antigens is a significant factor in the elevation of serum antigen levels.     

Serum concentration and immunohistochemical localization of SPan-1 antigen in pancreatic cancer. A comparison with CA19-9 antigen.

We studied SPan-1 antigen in 64 patients with pancreatic cancer by measuring serum concentrations with RIABEAD and examining the intratumor staining patterns immunohistochemically. Serum concentrations were elevated (greater than 30 U/ml) in 46 patients (72.0%), roughly the same percentage as with elevated serum CA19-9 concentrations. Ten out of 19 patients without CA19-9 antigen expressed SPan-1, and the combined rate of positivity was 86% (55/64). Immunohistochemically, CA19-9 was localized to the apical surface and the supranuclear cytoplasm of normal epithelial cells, but SPan-1 was localized to the supranuclear cytoplasm or throughout the cytoplasm. After malignant degeneration, both antigens were found over the entire plasma membrane, throughout the cytoplasm (loss of polar distribution) and in the stroma surrounding the cells. SPan-1 was detected in 48 out of 54 adeno-carcinomas of the pancreas (89%), and all cases with an elevated serum concentration displayed stromal staining in the cancer tissues. The utility of SPan-1 antigen as a tumor marker for diagnosing pancreatic cancer was found to be equal to that of CA19-9.     

胰腺癌患者血清 Dickkopf-1水平检测及其临床意义

目的：探讨Dickkopf-1（ DKK-1）在胰腺癌辅助诊断中的价值。方法采用ELISA法检测50例胰腺癌患者（胰腺癌组）和50例健康查体者（对照组）血清DKK-1水平,采用电化学发光法检查检测CA19-9水平;比较两组DKK-1表达情况及DKK-1、CA19-9诊断胰腺癌的敏感度、特异度和准确性。结果胰腺癌组血清DKK-1水平及阳性率均明显高于对照组（P均＜0．05）;DKK-1与CA19-9诊断胰腺癌的敏感度分别为52％、78％,P＜0．05;特异度分别为92％、84％,P＞0．05;准确性分别为72％、81％,P＞0．05;若两者联合检测则敏感度和准确性分别提高至90％和84％。结论胰腺癌患者血清DKK-1水平明显增高,可作为临床中胰腺癌的辅助诊断指标;血清DKK-1与CA 19-9联合检测有助于提高胰腺癌的诊断水平。     

Significance of serum receptor-binding cancer antigen (RCAS1) in pancreatic cancer and benign pancreatobiliary diseases.

BACKGROUND/AIMS: RCAS1 is a novel tumor marker, and there are no sufficient data about the utility of this antigen as a serum tumor marker and about its tumor specificity. We aimed at measuring the serum levels of RCAS1 in patients with pancreatic cancer and at determining its diagnostic efficacy. METHODS: Sera collected from patients with pancreas adenocarcinomas (39 cases) and benign biliary and pancreatic diseases (19 cases) and from healthy volunteers (13 cases) were analyzed for RCAS1 and the results compared with CA19-9. The relation between serum RCAS1 and tumor stage was also evaluated. RESULTS: The serum RCAS1 levels exceeded the normal limit in 92.3, 26.3, and 23.0% of the patients with pancreatic cancer and benign biliary and pancreatic diseases and healthy volunteers, respectively. RCAS1 had a specificity similar to that of CA19-9 in pancreatic cancer, whereas RCAS1 had a higher sensitivity (p < 0.05). Both tumor markers had similar predictive values of positive and negative tests for pancreatic cancer. The RCAS1 level was less influenced than the CA19-9 level by biliary stenoses. The median serum levels of RCAS1 increased, as the tumor stage increased. CONCLUSIONS: RCAS1 is a valuable serum marker for the diagnosis of pancreatic cancer. The RCAS1 and CA19-9 levels increase the diagnostic efficiency of each other in pancreatic cancer.     

Clinical usefulness of carbohydrate antigen 19-9 as a screening test for pancreatic cancer in an asymptomatic population

BACKGROUND AND AIM: Although the prognosis for pancreatic cancer is generally poor, it is well known that the survival rate for resected pancreatic cancer is much higher than that for more conservative treatment. The importance of early detection is emphasized for resection of pancreatic cancer. Measurement of serum carbohydrate antigen (CA) 19-9 has shown satisfactory sensitivity and predictive value in symptomatic patients, but no available data has been found on healthy asymptomatic subjects. Thus, the authors aimed to determine the clinical usefulness of CA 19-9 as a screening tool for pancreatic cancer in asymptomatic subjects. METHODS: From December 1994 to November 2000, 70 940 asymptomatic persons visiting the Health Promotion Center at the Samsung Medical Center, Seoul, Korea, participated. All subjects underwent abdominal ultrasonography and serum CA 19-9 measurement. The authors analyzed the sensitivity, specificity, and predictive values of CA 19-9 for detecting pancreatic cancer. Also, those subjects who had a serum CA 19-9 level above the cut-off value were followed up using a serial check of CA 19-9, computed tomography, or endoscopic retrograde cholangiopancreatography. RESULTS: The number of subjects with a level of CA 19-9 above the cutoff of 37 U/mL was 1063 (1.5%), including four cases diagnosed with pancreatic cancer. The prevalence of pancreatic cancer over the age of 30 years is 13.66 per 100 000 population in Korea. Therefore, the sensitivity is 100% and the specificity 98.5%. However, the positive predictive value of CA 19-9 for detecting pancreatic cancer is only 0.9% in the asymptomatic population. CONCLUSION: Mass screening for pancreatic cancer using CA 19-9 levels in asymptomatic subjects is ineffective because of a very low positive predictive value, despite its high sensitivity and specificity.     

Estimation of Carbohydrate Antigen (CA) 19-9 Levels in Pure Pancreatic Juice of Patients with Pancreatic Cancer

Carbohydrate antigen (CA) 19-9 levels in pure pancreatic juice from patients with pancreatic cancer, chronic pancreatitis, and other diseases were determined, and their clinical value was assessed. CA 19-9 levels in pancreatic juice were generally very high, compared with those in serum. In addition, the pancreatic juice CA 19-9 levels in patients with pancreatic cancer were significantly higher than those in patients with chronic pancreatitis and other various diseases used as controls. The assay of pancreatic juice CA 19-9 seemed to be valuable in the diagnosis of pancreatic cancer, showing a diagnostic value approximately similar to that of the serum CA 19-9 assay and clearly superior to that of the serum or pancreatic juice carcinoembryonic antigen assay.     

Serum level of TSGF, CA242 and CA19-9 in pancreatic cancer

AIM: To establish a method to detect the expression of the tumor specific growth factor TSGF, CA242 and CA19-9 in serum and evaluate their value in diagnosis of pancreatic cancer. METHODS: ELISA and Biochemical colorimetric assay were used to detect the serum content of TSGF, CA242 and CA19-9 in 200 normal cases, 52 pancreatitis patients and 96 pancreatic cancer patients. RESULTS: The positive likelihood ratios of TSGF, CA242 and CA19-9 were 5.4, 12.6 and 6.3, respectively, and their negative likelihood ratios were 0.10, 0.19 and 0.17, respectively. With single tumor marker diagnosed pancreatic cancer, the highest sensitivity and specificity of TSGF were 91.6% and 93.5%. In combined test with 3 markers, when all of them were positive, the sensitivity changed to 77.0% and the specificity and the positive predictive value were 100%. The levels of TSGF and CA242 were significantly higher in the patients with pancreatic cancer of head than those in the patients with pancreatic cancer of body, tail and whole pancreas, but the expression of CA19-9 had no correlation with the positions of the pancreatic cancer. The sensitivity of TSGF, CA242 and CA19-9 was increased with the progress in stages of pancreatic cancer. In stage I, the sensitivity of TSGF was markedly higher than CA242 and CA19-9. CONCLUSION: The combined use of TSGF, CA242 and CA19-9 expressions can elevate the specificity for pancreatic cancer diagnosis. And it shows that it plays an important role to differentiate positions and tissue typing. It is a forepart diagnosis for the pancreatic cancer by combination checking. There is very important correlation between the three markers and the pancreatic cancer.     

胰腺癌患者血清中巨噬细胞因子-1、糖链抗原19-9、糖链抗原242及癌胚抗原的检测分析

目的 探讨血清巨噬细胞因子-1（MIC-1）、糖链抗原（CA）19-9 、CA242及癌胚抗原（CEA）在胰腺癌中的应用价值.方法 分析129例胰腺癌患者和120例健康体检者4项肿瘤标志物的检测结果,计算各肿瘤标志物组合方式对提高胰腺癌诊断的作用.结果 胰腺癌患者血清中各项肿瘤标志物的水平与对照组比较差异有统计学意义（P〈0.05）.MIC-1＋CA19-9组合的敏感性与单项检测敏感性最高的MIC-1比较,差异有统计学意义（P〈0.05）;MIC-1＋CA19-9组合的特异性与单项检测特异性最高的CA19-9比较,差异无统计学意义（P〉0.05）.Ⅲ~Ⅳ期胰腺癌患者血清CA19-9、CA242水平与Ⅰ~Ⅱ期比较,差异有统计学意义（P〈0.05）.结论 4项肿瘤标志物的检测对胰腺癌的诊断均有一定的价值,MIC-1＋CA19-9联合检测可提高诊断的敏感性,同时未降低其特异性.CA19-9、CA242对判断胰腺癌的预后有一定价值.     

Clinical value of serum CA19-9 levels in evaluating resectability of pancreatic carcinoma

AIM： To evaluate the clinical value of serum CA19-9 levels in predicting the respectability of pancreatic carcinoma according to receiver operating characteristic （ROC） curve analysis.
METHODS： Serum CA19-9 levels were measured in 104 patients with pancreatic cancer which were possible to be resected according to the imaging. ROC curve was plotted for the CA19-9 levels. The point closest to the upper left-hand corner of the graph were chosen as the cut-off point. The sensitivity, specificity, positive and negative predictive values of CA19-9 at this cut-off point were calculated.
RESULTS： Resectable pancreatic cancer was detected in 58 （55.77%） patients and unresectable pancreatic cancer was detected in 46 （44.23%） patients. The area under the ROC curve was 0.918 and 95% CI was 0.843-0.992. The CA19-9 level was 353.15 U/mL, and the sensitivity and specificity of CA19-9 at this cutoff point were 93.1% and 78.3%, respectively. The positive and negative predictive value was 84.38% and 90%, respectively.
CONCLUSION： Preoperative serum CA19-9 level is a useful marker for further evaluating the resectability of pancreatic cancer. Obviously increased serum levels of CA19-9 （〉 353.15 U/mL） can be regarded as an ancillary parameter for unresectable pancreatic cancer.     

Clinical value of seram TAG-72 as a tumor marker for pancreatic carcinoma Comparison with CA 19-9

We evaluated the sensitivity and specificity of the carbohydrate antigen TAG-72 as a tumor marker for pancreatic cancer compared with the serum values of CA 19-9. Forty healthy controls, 58 patients with pancreatic carcinoma, and 45 patients with chronic pancreatitis were studied. In patients with pancreatic cancer, 47/58 (81%) and 26/58 (45%) had raised serum levels of CA 19-9 and TAG-72, respectively; the sensitivity of the tests was not influenced by jaundice. In the chronic pancreatitis patients, both CA 19-9 and TAG-72 were elevated in 2/45 patients (44%). Both tests showed a specificity of 95%. Consequently, the sensitivity of TAG-72 was too low compared with CA 19-9. Moreover, serum TAG-72 could not detect small pancreatic cancers. High levels of both tumor markers were found in advanced stages of cancer. No advantage was found using both CA 19-9 and TAG-72 for improving the detection of pancreatic cancer. TAG-72 serum levels > 10 U/mL are closely related to unresectability of the tumor. Only 4/17 (23 %) of patients with resectable tumor had high TAG-72 levels. Serum TAG-72 expression seems to be more frequent in poorly-differentiated tumors than in well-differentiated cancers (56 vs 30% positivity rate).     

Determination of CA 19-9 antigen in serum and pancreatic juice for differential diagnosis of pancreatic adenocarcinoma from chronic pancreatitis

Serum CA 19-9 levels were measured in 63 patients with ductal pancreatic adenocarcinoma and in 49 patients with chronic pancreatitis. Concentrations were abnormally high (greater than 40 U/ml) in 57 (90%) patients with cancer and only in 5 (10%) patients with chronic pancreatitis. All patients with falsely normal serum values had poorly differentiated carcinomas. Median CA 19-9 concentrations were progressively higher in patients with more advanced cancer. Fifteen of 16 (93%) patients with localized cancer has abnormal serum levels but only 5 (31%) of them had values greater than 120 U/ml, which was the highest score observed in patients with chronic pancreatitis. Pure pancreatic juice was obtained endoscopically from 23 patients with pancreatic cancer and from 20 with chronic pancreatitis. CA 19-9 concentrations in pancreatic juice were significantly higher in patients with cancer than in non-neoplastic patients. All 11 patients with resectable cancer investigated had a ratio of CA 19-9 to secretory protein concentration in pancreatic juice above the range of patients with chronic pancreatitis. We conclude that serum CA 19-9 determination is highly sensitive and specific for the differential diagnosis of pancreatic cancer versus chronic pancreatitis. However, moderately increased values (less than 120 U/ml), as seen in patients with localized pancreatic adenocarcinoma, are not conclusive for malignancy. The measurement of CA 19-9 to total protein ratio in pure pancreatic juice is proposed as an adjunctive, accurate diagnostic marker for early stages of pancreatic adenocarcinoma.     

Low efficacy of serum levels of CA 19-9 in prediction of malignant diseases in asymptomatic population in Taiwan

BACKGROUND/AIMS: Serum levels of carbohydrate antigen (CA) 19-9 have long been employed as a biomarker in diagnosing pancreatic cancer in symptomatic patients. We assessed the clinical usefulness of serum CA 19-9 in screening pancreatic cancer and other malignancies in individuals without symptoms. METHODOLOGY: The study enrolled 5,343 consecutive asymptomatic individuals who completed a health check-up comprising serum CA 19-9, chest film, abdominal ultrasonography, esophagogastroduodenoscopy, and colonoscopy or sigmoidoscopy. The sensitivity, specificity and positive predictive rate of CA 19-9 in detecting cancers were analyzed. RESULTS: There were 385 patients (7.2%) with CA 19-9 higher than 37 U/mL. Two patients diagnosed with pancreatic cancer had CA 19-9 levels of 46,885 U/mL and 88.4 U/mL, respectively. Thirteen among 58 patients with other cancers had CA 19-9 levels higher than 37 U/mL. If the cut-off value of CA 19-9 was set at 37 U/mL, the sensitivity and specificity for pancreatic cancer and other cancers were 100% and 92.8%, as well as 22.4% and 92.9%, respectively. However, the positive predictive rates for pancreatic cancer and other cancers were as low as 0.5% and 3.4%, respectively. CONCLUSIONS: Efficacy of CA 19-9 in predicting either pancreatic cancer or other cancers in the asymptomatic population is low.     

Factors affecting serum levels of CA 19-9 with special reference to benign hepatobiliary and pancreatic diseases

In order to elucidate the factors affecting the serum levels of CA 19-9, we analyzed sera of 79 patients with pancreatic cancer and 169 with non-malignant diseases, chiefly consisting of hepatobiliary and pancreatic diseases. Serum CA 19-9 values in patients with pancreatic cancer had no relation to the location of the tumor or presence of jaundice. Similarly, no tendency was observed as to the location and size of tumor or to the grade of differentiation in 12 CA 19-9-negative patients with pancreatic cancer. Serum levels of CA 19-9 in patients with cholelithiasis complicated by cholangitis frequently showed markedly high values, but then rapidly normalized in parallel with the subsiding of inflammation. The behaviour of serum CA 19-9 showed little relation to renal or hepatic failures or to intrahepatic cholestasis. However, slightly elevated levels of the antigen were found in more than half of those patients with fulminant hepatitis showing massive necrosis. In chronic pancreatitis, the prevalence was only 8%; however, an increase was observed at the time of exacerbation in 2 of 5 positive patients. There was hardly any increase in serum levels of CA 19-9 after endoscopic retrograde cholangiopancreatography (ERCP), although serum levels of pancreatic enzymes rose after ERCP in almost all patients. Thus, it appears that CA 19-9 does not easily escape into the bloodstream, unlike pancreatic enzymes.     

Comparison of tumor marker CA 242 with CA 19-9 and carcinoembryonic antigen (CEA) in pancreatic cancer

BACKGROUND/AIMS: Although there are a variety of tumor markers used for diagnosis of pancreatic carcinoma, the sensitivity and specificity of those markers have not yet reached an ideal level. The aim of this study was to compare the diagnostic value of CA 242 with CA 19-9 and CEA in the patients with pancreatic cancer. METHODOLOGY: Serum CA 242, CA 19-9 and CEA levels were determined in 135 subjects in the following groups: Pancreatic cancer (n = 40), cholangiocellular carcinoma (n = 15), hepatocellular carcinoma (n = 10), cirrhosis (n = 7), chronic active hepatitis (n = 7), choledochal stone (n = 12), chronic pancreatitis (n = 9), acute pancreatitis (n = 6), and healthy controls (n = 29). RESULTS: An elevated serum CA 242 concentration (> 20 U/mL) was found in 30 out of 40 (70%) (mean; 2163 +/- 838 U/mL) patients with pancreas cancer, in 11 out of 15 patients with cholangiocellular carcinoma (93.3%) (mean 916 +/- 529 U/mL), in none of patients with hepatocellular carcinoma and healthy controls. Slightly elevated CA 242 concentration was found in 6 out of 41 patients with benign hepatobiliary and pancreatic disease (range 0.4-97.8 U/mL) (1 acute pancreatitis, 2 chronic pancreatitis, 1 cirrhosis, 2 choledochal stone). Mean serum CA 242, CA 19-9 and CEA levels of the pancreas cancer group were significantly higher than those of the other groups except the cholangiocellular carcinoma group. There was no significant difference between the stage of pancreas cancer regarding mean serum CA 242, CA 19-9 and CEA level. There was positive correlation between serum CA 242 and CA 19-9 level. In the pancreas cancer, the sensitivity of CA 242, CA 19-9 and CEA was 75%, 80%, 40%, respectively and the specificity of those markers was 85.5%, 67.5% and 73%, respectively. CONCLUSIONS: In conclusion, the advantage of CA 242 compared to CA 19-9 is that its specificity is higher than that of CA 19-9 in the diagnosis of pancreas cancer.     

Carbohydrate antigenic determinant (CA 19-9) and other tumor markers in gastrointestinal malignancies

The serum carbohydrate antigenic determinant (CA 19-9) was assayed in patients with various diseases, and it provides excellent sensitivity for adenocarcinoma of the pancreas (25/27, 93%), while only 4% (2/54) of the patients with benign diseases and none of the 40 healthy subjects showed elevated CA 19-9 concentrations over 37 units/ml as upper normal value. Increased serum carcinoembryonic antigen (CEA) levels over 2.5 ng/ml were observed in patients with pancreatic cancer (18/22, 82%), compared to 22% (12/54) of the patients with benign diseases and 10% (4/40) of the healthy subjects. 12 of the 19, 6 of the 19 and none of the 22 patients with pancreatic cancer exhibited high serum ferritin, beta 2-microglobulin, or alpha-fetoprotein levels, respectively. A significant difference in CA 19-9 was found between patients with pancreatic cancer and gastric cancer, other gastrointestinal (GI) malignancies, other non-GI malignancies, benign digestive diseases or normal populations.     

Various tumor markers for small pancreatic cancer with special reference to the present status of pancreatic cancer in Japan and our experience over the past 2 years

Various tumor markers for detection of small pancreatic cancer less than 4.0 cm of diameter were evaluated and our recent 2 year experience is presented. Even in T1 cancer, 62.5% of the patients (N = 24) had elevated serum CA 19-9 and 56.5% of the patients also had elevated serum SPan-1. However, that of other markers was less than 30% except for CA 50 (60%). In T2 cancer, the highest sensitivity was observed for SPan-1 (79.6%, N = 54) and that of Ca 19-9 (N = 54) was also high (77.7%). That of other markers was less than 50%. The combination assay of CA 19-9 and SPan-1 in T1 cancer increased sensitivity from a single assay of 62.5% and 56.5%, respectively, to 70%. In T2 cancer, the sensitivity of the combination was 97.1%. All of our cases showed positive results using serum SPan-1 and/or CA 19-9 before confirming the diagnosis with imaging procedures. By applying measurements accurately, the test is a very useful adjunct to the diagnosis of small pancreatic cancer and therefore improves its prognosis.     

Comparative studies on expression of CA 19-9 and DU-PAN-2 in pancreatic cancer tissue

Thirty-eight human pancreatic cancer cases were examined by immunohistochemistry for expression of CA 19-9 and DU-PAN-2 antigens by the respective monoclonal antibodies. CA 19-9 was expressed in 82% and DU-PAN-2 in 87% of cases. A combination of two antibodies increased the reactivity to 97%. Six CA 19-9-negative cases were DU-PAN-2 positive and 4 DU-PAN-2-negative cases expressed CA 19-9. In only 1 case (an anaplastic carcinoma), neither of the antibodies was reactive with cancer cells. The reactivity of tumor cells with each of the antibodies varied from case to case, and, within the same tumor, from one area to another. Histologically, all but one tumor were adenocarcinomas. Thirty-five cases showed areas of either a moderate degree of differentiation (16 cases), poor differentiation (11 cases) or anaplastic areas (8 cases). Although both antigens were expressed in a greater number of cancer cells in well differentiated areas, and less frequently in poorly differentiated and anaplastic regions, the difference in antigen expression in relation to the degree of tumor differentiation was not statistically significant. The cellular localization of the antigens varied. DU-PAN-2 was primarily localized within the cytoplasm, whereas CA 19-9 was found mostly on the luminal cell surface and in luminal content of the glandular structure. In tumor-free pancreatic tissue, adjacent to the tumor, CA 19-9 was detected almost exclusively in the cells of large and medium sized ducts, whereas DU-PAN-2 was primarily expressed in terminal ductular and centrocinar cells. The results indicate that a cocktail of CA 19-9 and DU-PAN-2 antibodies could increase the likelihood of identifying a biomarker in most patients with pancreatic cancer.     

Comparative studies on expression of CA 19-9 and DU-PAN-2 in pancreatic cancer tissue

Summary Thirty-eight human pancreatic cancer cases were examined by immunohistochemistry for expression of CA 19-9 and DU-PAN-2 antigens by the respective monoclonal antibodies. CA 19-9 was expressed in 82% and DU-PAN-2 in 87% of cases. A combination of two antibodies increased the reactivity to 97%. Six CA 19-9-negative cases were DU-PAN-2 positive and 4 DU-PAN-2-negative cases expressed CA 19-9. In only 1 case (an anaplastic carcinoma), neither of the antibodies was reactive with cancer cells. The reactivity of tumor cells with each of the antibodies varied from case to case, and, within the same tumor, from one area to another. Histologically, all but one tumor were adenocarcinomas. Thirty-five cases showed areas of either a moderate degree of differentiation (16 cases), poor differentiation (11 cases) or anaplastic areas (8 cases). Although both antigens were expressed in a greater number of cancer cells in well differentiated areas, and less frequently in poorly differentiated and anaplastic regions, the difference in antigen expression in relation to the degree of tumor differentiation was not statistically significant. The cellular localization of the antigens varied. DU-PAN-2 was primarily localized within the cytoplasm, whereas CA 19-9 was found mostly on the luminal cell surface and in luminal content of the glandular structure. In tumor-free pancreatic tissue, adjacent to the tumor, CA 19-9 was detected almost exclusively in the cells of large and medium sized ducts, whereas DU-PAN-2 was primarily expressed in terminal ductular and centrocinar cells. The results indicate that a cocktail of CA 19-9 and DU-PAN-2 antibodies could increase the likelihood of identifying a biomarker in most patients with pancreatic cancer.     

Prognostic significance of serum CA19-9 levels in resected pancreatic cancer

Twenty-eight patients with histologically proven pancreatic adenocarcinoma were investigated to evaluate the utility of serum CA19-9 levels as a prognostic indicator after pancreatic resection. Three patients were excluded from the study because their serum CA19-9 levels remained normal throughout the course of the disease. Of the remaining 25 patients, those with preoperative serum CA19-9 levels ≤200U/ml had a better prognosis than those with serum CA19-9 levels >200 U/ml; however, the difference between the two groups was not significant (P=0.13). Serum CA19-9 levels 30 days after pancreatic resection were normalized (≤37 U/ml) in 11 patients (group A), and the survival rate of this group was significantly higher than that of the group of patients with persistently elevated CA19-9 levels (>37 U/ml) (group B) (P<0.005). Other factors i.e., preoperative CA19-9 values, tumor size, lymph node metastasis, histology, and stage classification showed no significant differences between group A and group B. Univariate analysis of the findings for the 25 patients showed that the stage classification and postoperative CA19-9 levels were of prognostic significance for prolonged survival. Other factors, i.e., gender, age, histology, preoperative CA19-9 levels, location of the tumor, and mode of operation, had no significance as prognostic indicators. Multivariate analysis showed that postoperative CA19-9 level was the only significant independent predictor of poor survival. Postoperative serum CA19-9 level appears to be useful as a prognostic indicator after resection of pancreatic cancer.     

The diagnostic importance of CEA and CA 19-9 for the early diagnosis of pancreatic carcinoma

BACKGROUND/AIMS: CA 19-9 and CEA were evaluated for their specificity and sensitivity in the early diagnosis of pancreatic carcinoma. METHODOLOGY: This prospective study included 40 patients with pancreatic carcinoma. A control group of 60 patients were divided into two subgroups as upper gastrointestinal system malignancies and benign pancreatic disorders. CEA and CA 19-9 levels were measured in all the patients. RESULTS: When the reference value of CA 19-9 was accepted as 74 U/mL, the specificity was 100% when pancreatic carcinoma was compared with benign disorders of the pancreas, but it's specificity for upper gastrointestinal malignancies was 60-90%. When the reference value of CEA was increased, the sensitivity had been decreased but the specificity had been increased when compared with the control group. If the reference value of CEA was accepted as 5 ng/mL, the specificity was 100% when pancreatic carcinoma was compared with acute or chronic pancreatitis, but it is less specific for the differential diagnosis of pancreatic carcinoma from the upper gastrointestinal malignancies. CONCLUSIONS: With the progression of the pancreatic carcinoma, serum CEA level and the specificity of CEA were elevated similar to that of CA 19-9. However, the elevation of CEA specificity when compared with the control group was lower than the specificity of the CA 19-9 and the sensitivity of CA 19-9 was superior to that of CEA for pancreatic carcinoma. The level of CA 19-9 was increased with the development of early pancreatic cancer and this elevation steadily continued with the progression of the cancer.