Lead-Time Trajectory of CA19-9 as an Anchor Marker for Pancreatic Cancer Early Detection.


There is substantial interest in liquid biopsy approaches for cancer early detection among subjects at risk, using multi-marker panels. CA19-9 is an established circulating biomarker for pancreatic cancer; however, its relevance for pancreatic cancer early detection or for monitoring subjects at risk has not been established.

CA19-9 levels were assessed in blinded sera from 175 subjects collected up to 5 years before diagnosis of pancreatic cancer and from 875 matched controls from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. For comparison of performance, CA19-9 was assayed in blinded independent sets of samples collected at diagnosis from 129 subjects with resectable pancreatic cancer and 275 controls (100 healthy subjects; 50 with chronic pancreatitis; and 125 with noncancerous pancreatic cysts). The complementary value of 2 additional protein markers, TIMP1 and LRG1, was determined.

In the PLCO cohort, levels of CA19-9 increased exponentially starting at 2 years before diagnosis with sensitivities reaching 60% at 99% specificity within 0 to 6 months before diagnosis for all cases and 50% at 99% specificity for cases diagnosed with early-stage disease. Performance was comparable for distinguishing newly diagnosed cases with resectable pancreatic cancer from healthy controls (64% sensitivity at 99% specificity). Comparison of resectable pancreatic cancer cases to subjects with chronic pancreatitis yielded 46% sensitivity at 99% specificity and for subjects with noncancerous cysts, 30% sensitivity at 99% specificity. For prediagnostic cases below cutoff value for CA19-9, the combination with LRG1 and TIMP1 yielded an increment of 13.2% in sensitivity at 99% specificity (P = .031) in identifying cases diagnosed within 1 year of blood collection.

CA19-9 can serve as an anchor marker for pancreatic cancer early detection applications.

  • Babic A
  • Brais L
  • Bullock A
  • Chabot JA
  • Clancy TE
  • Dennison JB
  • Do KA
  • Fahrmann JF
  • Genkinger J
  • Hanash S
  • Irajizad E
  • Jajoo K
  • Kastrinos F
  • Kluger MD
  • Lee LS
  • Loftus M
  • Long JP
  • Maitra A
  • Mao X
  • Ng K
  • Patel N
  • Schmidt CM
  • Vykoukal J
  • Wolpin BM
  • Yip-Schneider MT
  • Zhang J
  • Zhang J
PubMed ID
Appears In
Gastroenterology, 2021, 160 (4)