Pancreatic cancer study shares findings
LATEST RESEARCH: To establish new CA19-9 thresholds and better predict cancer patients’ prognosis, researchers examined genetic variants in 615 people
By Lee I-chia / Staff reporter
A study by researchers at the National Health Research Institutes (NHRI) found that having low levels of serum carbohydrate antigen 19-9 (CA19-9), a pancreatic tumor biomarker, in people with pancreatic cancer does not necessarily indicate a better prognosis.
NHRI’s National Institute of Cancer Research assistant investigator and attending physician Su Yung-yeh (蘇勇曄) said pancreatic cancer is the seventh leading cause of cancer death in Taiwan, and about 80 percent of patients were diagnosed at an advanced stage, with five-year survival of only about 13.7 percent.
Doctors typically use CA19-9 levels to assess a person’s risk, helping them decide treatment options and monitor treatment response, he said, adding that CA19-9 (also known as Sialyl Lewis antigen A) is a tumor marker protein that can be measured through a blood test and is typically elevated in people with pancreatic cancer.
National Health Research Institutes’ National Institute of Cancer Research assistant investigator and attending physician Su Yung-yeh, second right, poses with institute officials during a news conference in Taipei yesterday.
Photo: CNA
It is generally believed that higher levels of CA19-9 indicate more advanced disease and a worse prognosis, and that a value below 37 units per milliliter (U/ml) is considered normal, making it a key indicator, Su said.
However, about 10 percent of people with pancreatic cancer do not have elevated CA19-9 levels, even in cases of advanced disease, Su said.
These people’s low CA19-9 levels are actually influenced by genetics — genetic polymorphisms in the FUT3 genes — that impairs CA19-9 production, he said.
Doctors without access to people’s genotyping cannot distinguish Lewis antigen-negative people with advanced disease from those with genuinely low tumor burden.
To establish new CA19-9 thresholds for Lewis antigen-negative people and better predict their prognosis, the research team examined FUT2/FUT3 genetic variants in 615 people with pancreatic cancer at National Cheng Kung University Hospital and Kaohsiung Medical University Hospital in Taiwan.
They identified a CA19-9 level of 7U/ml or less as a new threshold for identifying people with pancreatic cancer who have the Lewis antigen-negative genotype, Su said.
The study also found that Lewis antigen-negative people with a CA19-9 level of 7U/ml or less experienced outcomes comparable to patients with CA19-9 levels of greater than 200 units/mL, he said.
Patients with CA19-9 levels of 7U/ml or less had a median overall survival of 13.5 months, similar to the median overall survival of 12.8 months seen in people with levels of more than 200U/ml, he said, adding that it suggested levels of 7U/ml or less might be prognostic of high-risk disease
In comparison, those with CA19-9 levels between 7U/ml and 37U/ml had a median overall survival of 23.2 months, while people with levels greater than 37U/ml to 200 units/mL had a median overall survival of 22 months, he added.
Su said that they suggest using a dual-threshold CA19-9 model with a cutoff of 7U/ml or less to identify high-risk Lewis antigen-negative patients, and improve their risk stratification and prevent underestimation of their disease severity.
The study was published in the journal Clinical Cancer Research in May, the NHRI said.
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