Serum CA19-9 Is Significantly Upregulated up to 2 Years before Diagnosis with Pancreatic Cancer: Implications for Early Disease Detection

TLDR

Biomarkers for the early detection of pancreatic cancer are urgently needed. The study aimed to determine whether serum levels of CA19‑9, CA125, CEACAM1, and REG3A rise before pancreatic cancer diagnosis and to evaluate the combined performance of these markers for early detection and prognosis. The authors conducted a nested case‑control study using UKCTOCS samples, randomly split into training and test sets, measured the markers by ELISA/CLIA, and assessed their diagnostic performance at various lead times. At 95 % specificity, CA19‑9 alone detected 68 % of cancers within one year and 53 % within two years; adding CA125 increased sensitivity, with CA125 elevated in about 20 % of CA19‑9‑negative cases, while CEACAM1 and REG3A contributed little; lead times averaged 20–23 months, and prediagnostic CA19‑9 and CA125 levels were associated with poorer overall survival (HR 2.69 and 3.15), demonstrating that these markers can identify preclinical pancreatic cancer earlier than previously thought.

Abstract

Biomarkers for the early detection of pancreatic cancer are urgently needed. The primary objective of this study was to evaluate whether increased levels of serum CA19-9, CA125, CEACAM1, and REG3A are present before clinical presentation of pancreatic cancer and to assess the performance of combined markers for early detection and prognosis.This nested case-control study within the UKCTOCS included 118 single and 143 serial serum samples from 154 postmenopausal women who were subsequently diagnosed with pancreatic cancer and 304 matched noncancer controls. Samples were split randomly into independent training and test sets. CA19-9, CA125, CEACAM1, and REG3A were measured using ELISA and/or CLIA. Performance of markers to detect cancers at different times before diagnosis and for prognosis was evaluated.At 95% specificity, CA19-9 (>37 U/mL) had a sensitivity of 68% up to 1 year, and 53% up to 2 years before diagnosis. Combining CA19-9 and CA125 improved sensitivity as CA125 was elevated (>30 U/mL) in approximately 20% of CA19-9-negative cases. CEACAM1 and REG3A were late markers adding little in combined models. Average lead times of 20 to 23 months were estimated for test-positive cases. Prediagnostic levels of CA19-9 and CA125 were associated with poor overall survival (HR, 2.69 and 3.15, respectively).CA19-9 and CA125 have encouraging sensitivity for detecting preclinical pancreatic cancer, and both markers can be used as prognostic tools. This work challenges the prevailing view that CA19-9 is upregulated late in the course of pancreatic cancer development.