Serum levels of LDH, CEA, and CA19-9 have prognostic roles on survival in patients with metastatic pancreatic cancer receiving gemcitabine-based chemotherapy

Cancer Chemother Pharmacol. 2014 Jun;73(6):1163-71. doi: 10.1007/s00280-014-2450-8. Epub 2014 Mar 20.


Purpose: Serum LDH, CEA, and CA19-9 levels are important tumor markers in pancreatic cancer. The purpose of this study was to evaluate the clinical significance of serum LDH, CEA, and CA19-9 levels in metastatic pancreatic cancer (MPC) receiving gemcitabine-based chemotherapy.

Materials and methods: In this retrospective study, we analyzed the outcome of 196 MPC patients who are treated with gemcitabine-based chemotherapy in our clinic.

Results: Positivity rates of serum LDH, CEA, and CA19-9 were 22, 40, and 83 %, respectively. Likewise, the rates of very high serum levels of tumor markers were correlated with these positivity rates (9 % for LDH, 30 % for CEA, and 55 % for CA19-9). The serum LDH levels were significantly higher in older patients (p = 0.05) and also in the patients with large tumors (p = 0.05), hepatic metastasis (p = 0.01), hypoalbuminemia (p = 0.01), and unresponsive to chemotherapy (p = 0.04). However, no correlation was found between both serum CEA and CA19-9 levels and possible prognostic factors (p > 0.05). The significant relationships were found between the serum levels of CEA and CA19-9 (r s = 0.24, p = 0.004), and serum LDH and CEA (r(s) = 0.193, p = 0.02). But, there was no correlation between serum LDH and CA19-9 levels (p = 0.39). One-year overall survival rate was 12.8 % (95 % CI 8-18). Increased serum levels of all the tumor markers significantly had adverse affect on survival (p = 0.001 for LDH, p = 0.002 for CEA, and p = 0.007 for CA19-9). However, no difference was observed in between high levels and very high levels of serum markers for all tumor markers (p > 0.05). Patients with normal serum levels of all three tumor markers had better outcome than others (p = 0.002) and those with normal serum LDH and CEA levels (whatever CA19-9) levels had associated with better survival compared with other possible alternatives (p < 0.001).

Conclusion: Serum levels of LDH, CEA, and CA19-9 had significant affect on survival in MPC patients.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • CA-19-9 Antigen / blood*
  • Carcinoembryonic Antigen / blood*
  • Deoxycytidine / administration & dosage
  • Deoxycytidine / adverse effects
  • Deoxycytidine / analogs & derivatives
  • Female
  • Humans
  • Lactate Dehydrogenases / blood*
  • Male
  • Middle Aged
  • Neoplasm Metastasis
  • Pancreatic Neoplasms / blood*
  • Pancreatic Neoplasms / drug therapy*
  • Pancreatic Neoplasms / pathology
  • Prognosis
  • Retrospective Studies


  • CA-19-9 Antigen
  • Carcinoembryonic Antigen
  • Deoxycytidine
  • gemcitabine
  • Lactate Dehydrogenases