The value of preoperative carcinoembryonic antigen and cancer antigen 19-9 blood levels as predictive factors for irresectability in pancreatic cancer patients

Abstract

Introduction: In addition to preoperative imaging, the tumor markers carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are used to predict irresectability of pancreatic cancer. However, optimal cut-off values for CEA and CA19-9 are still disputable. This study aimed to assess the value of preoperative CEA and CA19-9 blood levels as predictors for irresectability in patients with pancreatic adenocarcinoma discussed at the pancreatic multidisciplinary team (MDT) meetings in a tertiary referral center. Methods: Patients with pancreatic adenocarcinoma discussed at the MDT meetings from 2013 through 2017 were reviewed. The optimal cut-off values of both CEA and CA19-9 for the prediction of irresectable disease were determined using receiver operating characteristic curves, followed by a multivariable analysis. Results: In total, 376 patients were included. The optimal cut-off values for predicting irresectability were 7.0 ng/ml for CEA and 304.8 U/ml for CA19-9, resulting in a positive predictive value of 85% for CEA>7.0 ng/ml and 75% for CA19-9>304.8 U/ml (Figure 1: percentages indicate number of patients above and under the optimal cut-off values). Both tumor markers were independent predictors of irresectability, demonstrated by an odds ratio of 4.25 (95%CI: 1.88-9.64; P< 0.001) for CEA and 2.64 for CA19-9 (95%CI: 1.32-5.26; P=0.006). Conclusion: The results of this study show that the predictive value of preoperative CEA for irresectability is better than CA19-9 in pancreatic adenocarcinoma patients, which demonstrates that implementing CEA serum levels during MDT meetings as an additional tool for establishing tumor resectability is worthwhile.