Proposed cut-off value of CA19-9 for detecting pancreatic cancer in patients with diabetes: a case-control study

Abstract

Pancreatic cancer is a highly lethal malignancy. CA19-9 is a well-known marker for diagnosis of pancreatic cancer, but the serum CA19-9 level is reported to be elevated in patients with poorly controlled diabetes. This study evaluated the sensitivity, specificity, and cut-off value of serum CA19-9 for detection of pancreatic cancer in patients with diabetes. A case-control study of 236 patients was performed. The case group was selected from diabetic patients with pancreatic cancer, while one control was selected for each case from among diabetic patients without pancreatic cancer during the same period. The case group (n = 118) and the control group (n = 118) were matched for age, sex, and pancreatic cancer risk factors. Receiver operating characteristic (ROC) curves were plotted to determine the serum CA19-9 level that predicted pancreatic cancer. Then the sensitivity and specificity of CA19-9 were calculated for the threshold value. There were no significant differences of age, sex, BMI, smoking, alcohol intake, and HbA1c between the case and control groups. According to ROC analysis, a serum CA19-9 level of 75 U/mL had the maximum sensitivity and specificity for separating diabetic patients with or without pancreatic cancer. Using this cut-off value, the sensitivity and specificity of CA19-9 for pancreatic cancer was 69.5% and 98.2%, respectively, while the area under the ROC curve was 0.875 [95%CI: 0.826-0.924]. We propose that a serum CA19-9 level of 75 U/mL should be used as the cut-off value when screening patients with diabetes for pancreatic cancer.

Serum CA 19–9 Level is Correlated to the Clinical Characteristics and Chronic Complications of Patients Newly Diagnosed with Type 2 Diabetes Mellitus

“…After treatment of hyperglycemic state, the serum CA 19-9 levels of diabetic patients were more than 57.14 U/ml, in which the presence of malignancy diseases should be suspected and evaluated. Recently, Mariko, Murakami, et al proposed that 75 U/ml serum CA 19-9 should be used as the cutoff value in screening pancreatic cancer in patients with diabetes because the sensitivity and specificity of serum CA 19-9 are 69.5 % and 98.2 % [19], respectively.…”

Early prediction of pancreatic cancer from new-onset diabetes: an Associazione Italiana Oncologia Medica (AIOM)/Associazione Medici Diabetologi (AMD)/Società Italiana Endocrinologia (SIE)/Società Italiana Farmacologia (SIF) multidisciplinary consensus position paper

“…42 A cut-off of 75 U/ml showed a sensitivity and specificity of 69.5% and 98.2% for the detection of PC, respectively, but mostly in advanced stages. 5 It has moreover been reported that w5% of the population are Lewis blood group-negative [Le (a-b-)] and cannot synthesize CA19-9: these individuals may show false negative levels of CA19-9. 43 Circulating tumor DNA.…”

“…PC prognosis is extremely poor (overall survival <10% at 5 years): this is largely due to the difficulties in identifying PC at an early stage as well as its aggressive behaviour (local invasion, distant metastases, and poor response to therapy). 4 , 5 The development of strategies for early diagnosis of resectable PC is therefore critical for improved survival rates.…”

Recent Advances in Nanoparticle-Mediated Diagnosis and the Treatment of Pancreatic Cancer

“…Tsai et al [ 17 ] have measured CA 19-9 levels before and after PC surgery and neoadjuvant chemotherapy, proving that its levels before treatment can predict outcome, since failure to normalize was correlated with poor prognosis for this category of patients. However, another team of researchers point out that CA 19-9 levels can be elevated in diabetic patients, therefore proposing a cut-off of 75 U/mL for separating diabetics from pancreatic cancer patients [ 18 ]. This is important to keep in mind when evaluating this marker’s levels, especially as long as diabetes is a common disease.…”