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Lead-Time Trajectory of CA19-9 as an Anchor Marker for Pancreatic Cancer Early Detection.
- Source :
-
Gastroenterology [Gastroenterology] 2021 Mar; Vol. 160 (4), pp. 1373-1383.e6. Date of Electronic Publication: 2020 Dec 14. - Publication Year :
- 2021
-
Abstract
- Background & Aims: There is substantial interest in liquid biopsy approaches for cancer early detection among subjects at risk, using multi-marker panels. CA19-9 is an established circulating biomarker for pancreatic cancer; however, its relevance for pancreatic cancer early detection or for monitoring subjects at risk has not been established.<br />Methods: CA19-9 levels were assessed in blinded sera from 175 subjects collected up to 5 years before diagnosis of pancreatic cancer and from 875 matched controls from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. For comparison of performance, CA19-9 was assayed in blinded independent sets of samples collected at diagnosis from 129 subjects with resectable pancreatic cancer and 275 controls (100 healthy subjects; 50 with chronic pancreatitis; and 125 with noncancerous pancreatic cysts). The complementary value of 2 additional protein markers, TIMP1 and LRG1, was determined.<br />Results: In the PLCO cohort, levels of CA19-9 increased exponentially starting at 2 years before diagnosis with sensitivities reaching 60% at 99% specificity within 0 to 6 months before diagnosis for all cases and 50% at 99% specificity for cases diagnosed with early-stage disease. Performance was comparable for distinguishing newly diagnosed cases with resectable pancreatic cancer from healthy controls (64% sensitivity at 99% specificity). Comparison of resectable pancreatic cancer cases to subjects with chronic pancreatitis yielded 46% sensitivity at 99% specificity and for subjects with noncancerous cysts, 30% sensitivity at 99% specificity. For prediagnostic cases below cutoff value for CA19-9, the combination with LRG1 and TIMP1 yielded an increment of 13.2% in sensitivity at 99% specificity (P = .031) in identifying cases diagnosed within 1 year of blood collection.<br />Conclusion: CA19-9 can serve as an anchor marker for pancreatic cancer early detection applications.<br /> (Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Diagnosis, Differential
Feasibility Studies
Female
Healthy Volunteers
Humans
Liquid Biopsy methods
Male
Middle Aged
Pancreatic Cyst blood
Pancreatic Cyst diagnosis
Pancreatic Neoplasms blood
Pancreatitis, Chronic blood
Pancreatitis, Chronic diagnosis
Sensitivity and Specificity
United States
CA-19-9 Antigen blood
Early Detection of Cancer methods
Mass Screening methods
Pancreatic Neoplasms diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1528-0012
- Volume :
- 160
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 33333055
- Full Text :
- https://doi.org/10.1053/j.gastro.2020.11.052