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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinical characteristics and outcomes in carbohydrate antigen 19-9 negative pancreatic cancer
Daniel Vasile Balaban, Flavius Stefan Marin, George Manucu, Andreea Zoican, Marina Ciochina, Victor Mina, Cristina Patoni, Catalina Vladut, Sandica Bucurica, Raluca Simona Costache, Florentina Ionita-Radu, Mariana Jinga
Daniel Vasile Balaban, Flavius Stefan Marin, George Manucu, Andreea Zoican, Marina Ciochina, Victor Mina, Cristina Patoni, Sandica Bucurica, Raluca Simona Costache, Florentina Ionita-Radu, Mariana Jinga, Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Dr. Carol Davila Central Military Emergency University Hospital, Bucharest 020021, Romania
Flavius Stefan Marin, Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Paris 75014, France
Catalina Vladut, Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Prof Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest 020021, Romania
Author contributions: Balaban DV proposed the research idea; Balaban DV, Marin FS, Manucu G and Zoican A drafted the study design; Jinga M critically reviewed the manuscript; all authors were involved in patient recruitment, data analysis, literature review and drawing of figures and tables and contributed to the initial version of the manuscript.
Institutional review board statement: Local Ethics Committee approval no. 345/25.07.2019.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All authors declare no conflict of interest.
Data sharing statement: Data sharing is available upon request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Daniel Vasile Balaban, MD, PhD, Senior Lecturer, Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, Dr. Carol Davila Central Military Emergency University Hospital, Dionisie Lupu 37, Bucharest 020021, Romania. vbalaban@yahoo.com
Received: March 31, 2022
Peer-review started: March 31, 2022
First decision: April 28, 2022
Revised: May 19, 2022
Accepted: July 6, 2022
Article in press: July 6, 2022
Published online: July 24, 2022
BACKGROUND
Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of death from cancer worldwide. Tumor markers like carbohydrate antigen 19-9 (CA 19-9) have been proven valuable as a diagnostic tool and a predictor for tumor staging and response to therapy.
AIM
To delineate the phenotype of normal CA 19-9 PDAC according to clinical features, disease staging and prognosis as compared with high CA 19-9 PDAC cases.
METHODS
We performed a retrospective single-center analysis of all PDAC cases admitted in our Gastroenterology department over a period of 30 mo that were diagnosed by endoscopic ultrasound-guided tissue acquisition. Patients were divided into two groups according to CA 19-9 levels over a threshold of 37 U/mL. We performed a comparison between the two groups with regard to demographic and clinical data, biomarkers, tumor staging and 6-mo survival.
RESULTS
Altogether 111 patients were recruited with 29 having documented normal CA 19-9 (< 37 U/mL). In the CA 19-9 negative group of patients, 20.68% had elevated levels of both CEA and CA 125, 13.79% for CA 125 only whilst 17.24% for CEA only. The two groups had similar demographic characteristics. Abdominal pain was more frequently reported in positive vs negative CA 19-9 PDAC cases (76.83% vs 55.17%), while smoking was slightly more prevalent in the latter group (28.04% vs 31.03%). Tumors over 2 cm were more frequently seen in the positive CA 19-9 group, reflecting a higher proportion of locally advanced and metastatic neoplasia (87.7% vs 79.3%). Six-month survival was higher for the negative CA 19-9 group (58.62% vs 47.56%).
CONCLUSION
Elevated CA 19-9 at diagnosis seems to be associated with a more pronounced symptomatology, high tumor burden and poor prognosis compared to negative CA 19-9 PDAC cases. CEA and CA 125 can be adjunctive useful markers for PDAC, especially in CA 19-9 negative cases.
Core Tip: Given the large heterogeneity of pancreatic cancer, delineation of subgroups with different tumor biology is essential for personalized management. We outlined the phenotype of carbohydrate antigen 19-9 negative pancreatic cancer according to clinical features, disease staging and prognosis.
