Objective: In pancreatic cancer, the extent of the spread of the disease is considered to be the strongest prognostic factor. In addition, tumor markers, particularly CA 19-9, may also provide prognostic information. In this study, we evaluated the prognostic value of serum tumor markers CEA, CA 19-9, CA 242, CA 72-4 and hCGβ in pancreatic cancer. Methods: Preoperative serum samples were obtained from 160 patients with pancreatic cancer, including 10 with stage I, 25 with stage II, 24 with stage III and 101 patients with stage IV cancer. Quantitation of CEA, CA 19-9, CA 242, and CA 72-4 in serum was performed with commercial assays. HCGβ was measured with an in-house immunofluorometric assay based on monoclonal antibodies specific for the free β-subunit of hCG. Survival analysis was performed with univariate Kaplan-Meier life-tables and log-rank test, and with multivariate Cox regression analysis. Results: Of the tumor markers studied, CA 19-9 was most frequently elevated. Overall 2-year survival was 10%. Stage, tumor location and size, curative resection, and CEA, CA 72-4 and hCGβ were all found to be prognostic factors (p < 0.026) in univariate analysis. In multivariate analysis, each marker had independent prognostic value (p < 0.011) when analyzed individually but adjusting for stage. When all the covariates were included in the same model, the strongest prognostic factor was hCGβ followed by CA 72-4 and stage. The other clinical characteristics and serum tumor markers contributed insignificant prognostic information. Conclusions: All the tumor markers studied (CEA, CA 19-9, CA 242, CA 72-4, and hCGβ) had prognostic value in pancreatic cancer, and hCGβ, CA 72-4, and stage were the strongest independent prognostic factors in this study.

Keywords:
CA 19-9, CA 242, CA 72-4, Carcinoembryonic antigen, hCGβ, Pancreatic cancer, Prognosis, Survival, Tumor marker
1.
Finnish Cancer Registry: Cancer Statistics for Finland. http://www.cancerregistry.fi/eng/statistics.htm (accessed February 2003).
2.
Roder JD, Ott K: Digestive system tumors: Cancer of the pancreas; in Gospodarowicz MK, Henson DE, Hutter RVP, O’Sullivan B, Sobin LH, Wittekind C (eds): Prognostic Factors in Cancer, ed 2. New York, Wiley-Liss, 2001, pp 333–347.
3.
EGTM: Tumour markers in gastrointestinal cancers – EGTM recommendations. European Group on Tumour Markers. Anticancer Res 1999;19:2811–2815.
4.
Carriquiry LA, Pineyro A: Should carcinoembryonic antigen be used in the management of patients with colorectal cancer? Dis Colon Rectum 1999;42:921–929.
5.
Duffy MJ: Carcinoembryonic antigen as a marker for colorectal cancer: Is it clinically useful? Clin Chem 2001;47:624–630.
6.
Kalser MH, Barkin JS, Redlhammer D, Heal A: Circulating carcinoembryonic antigen in pancreatic carcinoma. Cancer 1978;42:1468–1471.
7.
Taylor OM, Cooper EH, Benson EA, McMahon MJ: The prognostic value of the tumour markers CA 195 and CEA in patients with adenocarcinoma of the pancreas. Eur J Surg Oncol 1992;18:508–513.
8.
Yasue M, Sakamoto J, Teramukai S, Morimoto T, Yasui K, Kuno N, Kurimoto K, Ohashi Y: Prognostic values of preoperative and postoperative CEA and CA19.9 levels in pancreatic cancer. Pancreas 1994;9:735–740.
9.
Takeuchi M, Kondo S, Sugiura H, Katoh H: Pre-operative predictors of short-term survival after pancreatic cancer resection. Hepatogastroenterology 1998;45:2399–2403.
10.
Lundin J, Roberts PJ, Kuusela P, Haglund C: Prognostic significance of serum CA 242 in pancreatic cancer. A comparison with CA 19-9. Anticancer Res 1995;15:2181–2186.
11.
Louhimo J, Carpelan-Holmstrom M, Alfthan H, Stenman UH, Jarvinen HJ, Haglund C: Serum HCGβ, CA 72-4 and CEA are independent prognostic factors in colorectal cancer. Int J Cancer 2002;101:545–548.
12.
Marcillac I, Troalen F, Bidart JM, Ghillani P, Ribrag V, Escudier B, Malassagne B, Droz JP, Lhomme C, Rougier P, Duvillard P, Prade M, Lugagne PM, Richard F, Poynard T, Bohuon C, Wands J, Bellet D: Free human chorionic gonadotropin β subunit in gonadal and nongonadal neoplasms. Cancer Res 1992;52:3901–3907.
13.
Louhimo J, Nordling S, Alfthan H, Von Boguslawski K, Stenman UH, Haglund C: Specific staining of human chorionic gonadotropin β in benign and malignant gastrointestinal tissues with monoclonal antibodies. Histopathology 2001;38:418–424.
14.
Louhimo J, Finne P, Alfthan H, Stenman UH, Haglund C: Combination of HCGβ, CA 19-9 and CEA with logistic regression improves accuracy in gastrointestinal malignancies. Anticancer Res 2002;22:1759–1764.
15.
Alfthan H, Haglund C, Roberts P, Stenman UH: Elevation of free β subunit of human choriogonadotropin and core β fragment of human choriogonadotropin in the serum and urine of patients with malignant pancreatic and biliary disease. Cancer Res 1992;52:4628–4633.
16.
Syrigos KN, Fyssas I, Konstandoulakis MM, Harrington KJ, Papadopoulos S, Milingos N, Peveretos P, Golematis BC: Beta human chorionic gonadotropin concentrations in serum of patients with pancreatic adenocarcinoma. Gut 1998;42:88–91.
17.
Sobin LH, Wittekind C (eds): TNM Classification of Malignant Tumours, ed 5. New York, Wiley-Liss, 1997, pp 227.
18.
Alfthan H, Schröder J, Fraser R, Koskimies A, Halila H, Stenman UH: Choriogonadotropin and its β subunit separated by hydrophobic-interaction chromatography and quantified in serum during pregnancy by time-resolved immunofluorometric assays. Clin Chem 1988;34:1758–1762.
19.
Alfthan H, Haglund C, Dabek J, Stenman UH: Concentrations of human choriogonadotropin, its β-subunit, and the core fragment of the β-subunit in serum and urine of men and nonpregnant women. Clin Chem 1992;38:1981–1987.
20.
Gattani AM, Mandeli J, Bruckner HW: Tumor markers in patients with pancreatic carcinoma. Cancer 1996;78:57–62.
© 2004 S. Karger AG, Basel
2004
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.