Elevated CEA and CA19-9 serum levels independently predict advanced pancreatic cancer at diagnosis

Biomarkers. 2020 Mar;25(2):186-193. doi: 10.1080/1354750X.2020.1725786. Epub 2020 Feb 13.


Purpose: It is suggested that tumour markers carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) could be used to predict the stage of pancreatic cancer. However, optimal cut-off values for CEA and CA19-9 are disputable. This study aimed to assess the value of CEA and CA19-9 serum levels at diagnosis of pancreatic ductal adenocarcinoma (PDAC) as predictors for the advanced stage of PDAC in patients discussed at pancreatic multidisciplinary team (MDT) meetings.Methods: Patients with suspected PDAC discussed at MDT meetings from 2013 to 2017 were reviewed, in order to determine optimal cut-off values of both CEA and CA19-9.Results: In total, 375 patients were included. Optimal cut-off values for predicting advanced PDAC were 7.0 ng/ml for CEA and 305.0 U/ml for CA19-9, resulting in positive predictive values of 83.3%, 73.6%, and 91.4% for CEA, CA19-9 and combined, respectively. Both tumour markers were independent predictors of advanced PDAC, demonstrated by an odds ratio of 4.21 (95% CI:1.85-9.56; p = 0.001) for CEA and 2.58 for CA19-9 (95% CI:1.30-5.14; p = 0.007).Conclusions: CEA appears to be a more robust predictor of advanced PDAC than CA19-9. Implementing CEA and CA19-9 serum levels during MDT meetings as an additional tool for establishing tumour resectability is worthwhile for tailored diagnostics.

Keywords: CA19-9; CEA; Carcinoembryonic antigen; carbohydrate antigen 19-9; diagnosis; pancreatic cancer.

MeSH terms

  • Adult
  • Aged
  • Biomarkers, Tumor / blood
  • CA-19-9 Antigen / blood*
  • Carcinoembryonic Antigen / blood*
  • Carcinoma, Pancreatic Ductal / blood*
  • Carcinoma, Pancreatic Ductal / diagnosis
  • Female
  • GPI-Linked Proteins / blood
  • Humans
  • Male
  • Middle Aged
  • Pancreatic Neoplasms / blood*
  • Pancreatic Neoplasms / diagnosis
  • Predictive Value of Tests
  • Severity of Illness Index


  • Biomarkers, Tumor
  • CA-19-9 Antigen
  • CEACAM5 protein, human
  • Carcinoembryonic Antigen
  • GPI-Linked Proteins