High serum levels of DUPAN2 antigen and CA19-9 in pancreatic cancer: correlation with immunocytochemical localization of antigens in cancer cells

We determined the concentration of serum DUPAN2 and CA19-9 in 43 pancreatic cancer patients by enzyme immunoassay, and compared the staining patterns of the antigens in the tissues of pancreatic cancer in order to clarify the mechanism of the elevation of serum DUPAN2 and CA19-9 levels in the patients. In 26 patients (60%), the serum DUPAN2 concentration was higher than 300 U/ml. This positive rate was not so high as that of CA19-9. However, seven out of the twelve CA19-9-negative patients were DUPAN2-positive. Using a combined assay of serum DUPAN2 and CA19-9, the diagnostic sensitivity for pancreatic cancer was 88% (38/43). Immunocytochemically, both DUPAN2 and CA19-9 were restricted to the apical surface and/or supranuclear cytoplasm in the normal pancreatic duct epithelia. In cancerous glands, however, the two were found over the entire surface and cytoplasm of the cancer cells--losing the polar distribution pattern of the antigen--and in the surrounding stroma adjacent to the cancer cells. DUPAN2 was detected in 47 (89%) out of 53 adenocarcinomas of the pancreas, and CA19-9 in 44 cases (83%). Cases with high serum antigen levels tended to display high proportions of stromal staining in the cancer tissues. These findings suggest that shedding of the antigen into the stroma adjacent to the malignant glands is one of the major mechanisms in the elevation of high serum DUPAN2 and CA19-9 levels.     

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.     

Clinical study of human pancreatic cancer-associated antigen (SPan-1 antigen) in hepatobiliary and pancreatic diseases

We studied clinical significance of serum SPan-1 antigen, which is human pancreatic cancer associated antigen, in hepatobiliary and pancreatic diseases employing newly developed kit. The sensitivity of serum SPan-1 antigen levels for pancreatic cancer, gallbladder carcinoma, hepatocellular carcinoma, bile duct cancer were 90.9%, 77.8%, 60.7%, 60.0% respectively. No correlation was found between serum SPan-1 antigen levels and total bilirubin levels. SPan-1 positivity in patients with hepatic disease including hepatocellular carcinoma was rather high, but there were few cases more than 100 U/ml. The mechanism of the elevated level was supposed to be release of the antigen from bile-duct epithelium, and this must be taken into consideration at diagnosis referred to serum SPan-1 antigen level.     

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.     

Monitoring of CA19-9 and SPan-1 can facilitate the earlier confirmation of progressing pancreatic cancer during chemotherapy

BackgroundMeasurement of objective response to chemotherapy using imaging modalities is sometimes difficult in pancreatic cancer (PC). We aimed to verify whether monitoring of serum tumor markers (TMs), namely carcinoembryonic antigen, CA19-9, DUPAN-2, SPan-1, can facilitate earlier confirmation of treatment failure.MethodsMonitoring of serum TMs and computed tomography were performed every 4 weeks until progression of disease in 90 patients with PC undergoing gemcitabine therapy. In Group A (January 2006–October 2007), we analyzed the fluctuation rates of TMs with high pretreatment positive rates, and defined the criteria of progressive disease under TM monitoring (TM-PD). In Group B (November 2007–October 2008), we calculated the time to progression (TTP) under this TM-PD criteria, which was compared with the TTP under the RECIST criteria.ResultsCA19-9 and SPan-1 had the highest pretreatment positive rates: 83% and 90%, respectively. In Group A (CA19-9, n = 38; SPan-1, n = 36), TM-PD criteria were defined as follows: fluctuation rates were ≥25% for a month or ≥10% for 2 consecutive months in CA19-9, and ≥10% for a month in SPan-1. In Group B (CA19-9, n = 18; SPan-1, n = 17), under these criteria, one-month earlier confirmation of treatment failure was feasible in 61% by CA19-9 and 59% by SPan-1. Furthermore, the combination could facilitate this determination in 72% (35/49), significantly better than CA19-9 alone (P = 0.004).ConclusionMonitoring of serum CA19-9 and SPan-1 is helpful for earlier confirmation of treatment failure during gemcitabine therapy in PC.     

Noninvasive diagnosis of advanced pancreatic cancer by real-time ultrasonography, carcinoembryonic antigen, and carbohydrate antigen 19-9

One-hundred-forty patients with clinical impression of pancreatic cancer were examined prospectively with three noninvasive tests: real-time ultrasonography, determination of serum carcinoembryonic antigen (CEA), and carbohydrate antigen (CA 19-9). Among them, 24 (17.1%) patients were found to have pancreatic cancer. The sensitivity of ultrasonography, CEA, and CA 19-9 was 72.9%, 70.8%, and 83.3%, respectively; the specificity was 94.0%, 77.6%, and 90.5%, respectively, and the diagnostic accuracy was 91.4%, 76.4%, and 89.3%, respectively. The combination of ultrasonography and determination of serum CA 19-9 had better sensitivity (95.8%), comparable specificity (84.5%), and comparable diagnostic accuracy (86.4%) to any individual test alone or any other combination. It was suggested that combined use of real-time ultrasonography and determination of serum CA 19-9 provided excellent noninvasive screening for patients suspected of having pancreatic cancer.     

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.     

Elevation of a tumor associated antigen CA 19-9 levels in patients with rheumatic diseases

We investigated the incidence and characteristics of an elevated tumor associated antigen CA 19-9 in patients with rheumatic diseases. Serum concentration of CA 19-9 was increased in 13 of 39 patients (33.3%) with definite or classical rheumatoid arthritis (RA), in 6 of 19 patients (31.6%) with systemic lupus erythematosus (SLE), in 3 of 9 patients (33.3%) with progressive systemic sclerosis (PSS) and in 9 of the other 35 patients (25.7%). Malignant neoplasm was not detected in any of the patients with rheumatic diseases. Pretreatment of mouse serum with patients' sera did not reduce the measured CA 19-9 values obtained by the conventional assay. The CA 19-9 antigen found in sera from patients with RA was present in a non-IgG fraction, and had the same molecular weight as that in one patient with pancreatic cancer, as determined by gel filtration. These results demonstrated that serum CA 19-9 levels were increased in some patients with rheumatic diseases.     

Serum tumor markers not useful in screening patients with pancreatic mucinous cystic lesions associated with malignant changes

BACKGROUND: Serum cancer antigen 19-9 (CA19-9) pro-vides additional information about mucinous cystic pancre-atic neoplasm (MPN). This study was undertaken to assess both CA19-9 and carcinoembryonic antigen (CEA) serum concentrations in consecutive patients affected by MPNs and other chronic benign and malignant pancreatic diseases. We also evaluated whether serum CA19-9 and CEA determina-tions provide additional information such as the presence of invasive carcinoma in MPN patients.
METHODS: Serum CA19-9 and CEA from 91 patients with pancreatic diseases were tested by commercially available kits at the time of diagnosis. The upper reference limit of serum CA19-9 was 37 U/mL and that of serum CEA was 3 ng/mL.
RESULTS: Thirty-ifve patients was diagnosed with chronic pancreatitis (CP), 32 with MPN, and 24 with pancreatic ductal adenocarcinoma (PDAC) conifrmed histologically. Surgery was carried out in 5 CP patients, in 10 MPN patients (7 of them had severe dysplasia), and 9 PDAC patients. Serum CA19-9 activity was high in 12 (34.3%) CP patients, in 7 (21.9%) MPN patients, and in 12 (50.0%) PDAC patients (P=0.089). High se-rum CEA concentrations were noted in 6 (17.1%) CP patients, in 6 (18.8%) MPN patients, and in 12 (50.0%) PDAC patients (P=0.010). In the 7 MPN patients associated with histological-ly conifrmed severe dysplasia, 3 (42.9%) patients had elevated serum activity of serum CA19-9, and 2 (28.6%) patients had high levels of CEA.
CONCLUSION: Serum determination of oncological markers is not useful in selecting MPN patients with malignant changes.     

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.     

Comparison of CA 72-4 with CA 19-9 and carcinoembryonic antigen in the serodiagnostics of gastrointestinal malignancies

Serum levels of the new tumor-associated marker CA 72-4 were measured in healthy controls (n = 64) and patients with benign (n = 410) or malignant (n = 199) gastrointestinal diseases. A cut-off limit of 4 U/ml was established. Tumor-indicating sensitivity was compared with that of the conventional markers carcinoembryonic antigen (CEA) and CA 19-9. In serodiagnostic evaluations CA 72-4 was clearly inferior to CA 19-9 in pancreatic carcinomas (22% versus 82%; all stages) and to CEA in colorectal cancer (32% versus 58%; all stages), with no appreciable diagnostic gain from combined determination. However, in gastric carcinoma CA 72-4 identified 59% of all patients (CA 19-9, 52%; CEA, 25%), and a combination of CA 72-4 and CA 19-9 detected as many as 70%. Positive results correlated roughly with tumor size. Compared with the other two tumor markers, CA 72-4 had a very high specificity (98%) in benign diseases of the gastrointestinal tract, including inflammatory processes, so that elevated serum levels of CA 72-4 should always be taken seriously.     

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.     

Clinical evaluation of pancreatic cancer-associated mucin expressing CA19-9, CA50, Span-1, sialyl SSEA-1, and Dupan-2.

We have previously described the purification and partial characterization of a new pancreatic cancer-associated antigen, a pancreatic cancer-associated mucin expressing CA19-9, CA50, Span-1, sialyl SSEA-1, and Dupan-2. This study describes the clinical evaluation of various assay systems for this antigen which depend on measuring respective serum levels. Elevated levels of antigen were detected in the sera from both patients with malignant and non-malignant diseases. However, elevated serum levels of CA19-9 and Lewisa and Lewisb epitopes on moieties were restricted to pancreatic and biliary tract cancers, although adequate sensitivity was not attained. Coordinate evaluation of these three markers improved the sensitivity to some extent without loss of specificity for the diagnosis of pancreatic and biliary tract cancers, because of the heterogeneity of the coexpression of these epitopes. We developed additional assay systems with a combination of this antigen and two lectins (Bauhinia purpurea (BPA) and Vicia villosa (VVA)). Elevated levels of BPA- and VVA-reactive antigens were detected in 41% and 31%, respectively, of pancreatic cancer sera samples. Few patients with chronic pancreatitis had an elevated serum level of either antigen, and higher elevated levels of these markers were restricted to the sera of patients with malignancies. Our results suggest that this antigen is found in the sera of patients with various conditions and in the sera of normal subjects but that antigens bearing CA19-9 or Lewisa or Lewisb epitopes and an altered carbohydrate structure recognized by BPA and VVA lectins are preferentially present in the sera of patients with pancreatic and other malignancies.     

Prospective evaluation of the diagnostic efficacy of CA 19-9 assay as a marker for gastrointestinal cancers

Levels of a new carbohydrate antigen, CA 19-9, which is a monosialoganglioside identified by a monoclonal antibody raised against colorectal carcinoma cells, were compared to conventional CEA assays in 615 sera from healthy controls, patients with benign gastrointestinal disorders, and patients with cancers of gastrointestinal or extragastrointestinal origin. Whereas CEA levels were higher in smokers, CA 19-9 values were independent of the smoking history. CA 19-9 was undetectable in lymphoma and myeloma patients, but some patients with extraintestinal epithelial cancers expressed this antigen in serum. For benign and malignant gastrointestinal diseases, CA 19-9 displayed higher sensitivity, specificity, and predictive values than CEA. CA 19-9 was elevated as frequently as CEA in patients with metastatic pancreatic cancer, but in patients with localized disease, CA 19-9 was elevated more often than was CEA. In colorectal cancer, patients with and without metastases were detected at similar rates by both assays. It is concluded that CA 19-9 is a marker of epithelial cancers, does not vary with the smoking status, and is superior to CEA in detecting gastrointestinal malignancies, especially those arising from the pancreatic gland.     

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.     

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.     

Comparative studies of DU-PAN-2, carcinoembryonic antigen, and CA19-9 in the serum and bile of patients with pancreatic and biliary tract diseases: evaluation of the influence of obstructive jaundice

The levels of DU-PAN-2 antigen, carcinoembryonic antigen, and CA19-9 in serum and bile of patients with pancreatic and biliary tract diseases were measured. The sensitivities (true positive) of DU-PAN-2 in serum to pancreatic carcinoma (64%) and to biliary tract carcinoma (62%) were similar to those of CA19-9 in serum (69% and 72%, respectively). Nine of 18 (50%) patients with CA19-9-negative pancreatic carcinoma tested positive for DU-PAN-2. The sensitivities of CEA to pancreatic carcinoma (56%) and to biliary tract carcinoma (52%) were lowest. The measurement of these antigens in bile seemed to be of little diagnostic value in differentiating between malignant and benign diseases. False positives of these three assays occurred frequently in patients with benign pancreatic or biliary tract disease coupled with obstructive jaundice. After percutaneous transhepatic biliary drainage, serum DU-PAN-2 and CA19-9 levels returned to normal ranges in patients with benign diseases, but not in patients with carcinoma of the pancreas or of the biliary tract. Serum CA19-9 and DU-PAN-2 antigens are useful tumor markers for pancreatic and biliary tract carcinomas. Longitudinal assays of these antigens may be useful for the differential diagnosis of patients with obstructive jaundice.     

High sensitivity and specificity of CA 19-9 for pancreatic carcinoma in comparison to chronic pancreatitis. Serological and immunohistochemical findings

The serum carbohydrate antigenic determinant (CA 19-9) was assayed in patients with various diseases (87 patients with pancreatic carcinoma, 747 patients with benign diseases, and 547 patients with extrapancreatic malignant growths) and it proved to be particularly sensitive for adenocarcinoma of the pancreas (80 of 87, 92%) as compared to only 14% in the group of patients with benign diseases. Twenty-seven percent of the patients with chronic pancreatitis and 28% of the patients with acute pancreatitis showed elevated CA 19-9 concentrations of more than the upper normal value of 37 U/ml. In 38% and 32% of our cases with carcinoma of the stomach and colorectal carcinoma, respectively, CA 19-9 was estimated as being above the normal range. The preoperatively raised CA 19-9 concentration in patients with pancreatic carcinoma decreases after curative resection of the carcinoma to values within the normal range. However, in no CA 19-9 estimation following a palliative surgical intervention or in cases of inoperable carcinomas a serum concentration of less than 37 U/ml was recorded. In immunohistochemical specimens we found a difference between CA 19-9 antigen concentrations on the cell surface and secretion in pancreatic carcinoma and chronic pancreatitis.     

CA 19-9 Assay in Differential Diagnosis of Pancreatic Carcinoma from Inflammatory Pancreatic Diseases

Levels of a new carbohydrate antigen CA 19-9, which is a monosialoganglioside identified by a monoclonal antibody raised against colorectal carcinoma cells, were compared to carcinoembryonic antigen and tissue polypeptide antigen assays in 250 sera from patients with different pancreatic diseases including acute pancreatitis, chronic pancreatitis, and pancreatic cancer. All three tumoral markers were elevated at the onset of an acute pancreatic attack in a few patients. All but five patients with chronic pancreatitis displayed normal levels with each of the three markers; in two of these five cases an extraintestinal cancer was later discovered. CA 19-9 displayed higher sensitivity and predictive value of a negative result than the other two markers. The best operational characteristic of CA 19-9 was its high predictive value for a positive test which suggests a "ruling in" usage of it for pancreatic cancer diagnosis. CA 19-9 assay was of extreme value in disclosing both localized and metastatic pancreatic cancer while the other two markers were more often positive in the latter case. Of 71 cancer patients with positive markers, only four would have escaped a right diagnosis by assaying CA 19-9 alone.     

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).