Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands.
Biomarkers. 2020 Mar;25(2):186-193. doi: 10.1080/1354750X.2020.1725786. Epub 2020 Feb 13.
It is suggested that tumour markers carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) could be used to predict the stage of pancreatic cancer. However, optimal cut-off values for CEA and CA19-9 are disputable. This study aimed to assess the value of CEA and CA19-9 serum levels at diagnosis of pancreatic ductal adenocarcinoma (PDAC) as predictors for the advanced stage of PDAC in patients discussed at pancreatic multidisciplinary team (MDT) meetings. Patients with suspected PDAC discussed at MDT meetings from 2013 to 2017 were reviewed, in order to determine optimal cut-off values of both CEA and CA19-9. In total, 375 patients were included. Optimal cut-off values for predicting advanced PDAC were 7.0 ng/ml for CEA and 305.0 U/ml for CA19-9, resulting in positive predictive values of 83.3%, 73.6%, and 91.4% for CEA, CA19-9 and combined, respectively. Both tumour markers were independent predictors of advanced PDAC, demonstrated by an odds ratio of 4.21 (95% CI:1.85-9.56; = 0.001) for CEA and 2.58 for CA19-9 (95% CI:1.30-5.14; = 0.007). CEA appears to be a more robust predictor of advanced PDAC than CA19-9. Implementing CEA and CA19-9 serum levels during MDT meetings as an additional tool for establishing tumour resectability is worthwhile for tailored diagnostics.
建议使用肿瘤标志物癌胚抗原（CEA）和糖类抗原 19-9（CA19-9）来预测胰腺癌的分期。然而，CEA 和 CA19-9 的最佳截断值存在争议。本研究旨在评估 CEA 和 CA19-9 血清水平在胰腺多学科团队（MDT）会议讨论的胰腺导管腺癌（PDAC）患者诊断时作为预测 PDAC 晚期的价值。对 2013 年至 2017 年 MDT 会议讨论的疑似 PDAC 患者进行了回顾性分析，以确定 CEA 和 CA19-9 的最佳截断值。共纳入 375 例患者。预测晚期 PDAC 的最佳 CEA 截断值为 7.0ng/ml，CA19-9 截断值为 305.0U/ml，CEA、CA19-9 和联合检测的阳性预测值分别为 83.3%、73.6%和 91.4%。两种肿瘤标志物均为晚期 PDAC 的独立预测因子，CEA 的优势比为 4.21（95%CI：1.85-9.56；P=0.001），CA19-9 的优势比为 2.58（95%CI：1.30-5.14；P=0.007）。CEA 似乎比 CA19-9 更能可靠地预测晚期 PDAC。在 MDT 会议期间将 CEA 和 CA19-9 血清水平作为额外的工具来评估肿瘤可切除性，以便进行针对性诊断，是值得的。
