Holistic Understanding of the Role of Carbohydrate Antigen 19-9 in Pancreatic Cancer Screening, Early Diagnosis, and Prognosis: A Systematic Review

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a significant challenge due to its silent progression and well-advanced, unresectable, complicated presentation. Detecting this disease early on is crucial, and researchers have been investigating various potential biological markers, such as carbohydrate antigen 19-9 (CA 19-9), hoping to find indicators that can aid in its early detection. The primary focus of this review is on the diagnostic usefulness of CA 19-9 in detecting pancreatic cancer (PC) in the beginning stage and its usefulness in predicting progression. The database search of articles from PubMed, PMC, the Cochrane Library, and Google Scholar identified 227 articles published from 2013 to 2023. The keyword mix used in the search technique included terms like "CA 19-9," "pancreatic cancer," "diagnosis," and "early detection." This study provides evidence of CA 19-9's ability in detecting PDAC in the pre-diagnostic stage. But since the outcomes were inconsistent among the included trials, further analysis is required to develop standardized diagnostic criteria and methodologies. Furthermore, because of the variability of the study, it is not easy to make firm conclusions on CA 19-9's sensitivity as well as specificity in the first stage of pancreatic neoplasm. This in-depth overview of the available literature provides new insights into using CA 19-9 as a biological marker for detecting undiagnosed PC before progressing into the advanced stage, and was proven beneficial. However, this has to be shown in broader research with adequate sample size. Although it shows promise as a diagnostic tool, further study is required to confirm these findings.

Targeted Nanoparticle-Based Diagnostic and Treatment Options for Pancreatic Cancer

“…Elevated carbohydrate antigen such as CA19-9 is a broadly studied and often-used screening tool in PDAC diagnosis and prognosis with a sensitivity of 79-81% and specificity of 82-90% in symptomatic patients, and 100% sensitivity and 98.5% specificity in asymptomatic patients. However, its positive predictive value (PPV) is only moderate at 72% in symptomatic patients and very low at 0.9% in asymptomatic patients, which makes it almost no clinical usage in practice for early detection [39,40]. Additionally, about 5-10% of Caucasians are Lewis antigen-negative, so they cannot produce detectable levels of CA19-9 [38,41].…”