Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2021; 27(6): 501-512
Published online Feb 14, 2021. doi: 10.3748/wjg.v27.i6.501
Validation of serum tumor biomarkers in predicting advanced cystic mucinous neoplasm of the pancreas
Li-Qi Sun, Li-Si Peng, Jie-Fang Guo, Fei Jiang, Fang Cui, Hao-Jie Huang, Zhen-Dong Jin
Li-Qi Sun, Li-Si Peng, Jie-Fang Guo, Fei Jiang, Fang Cui, Hao-Jie Huang, Zhen-Dong Jin, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
Author contributions: Sun LQ, Peng LS, and Guo JF contributed equally to this study and should be regarded as co-first authors; Sun LQ, Peng LS, and Guo JF were responsible for study design/planning, study conduct, data analysis, and writing and revising the paper; Jiang F and Cui F assisted with data collection and analysis; Jin ZD and Huang HJ designed the study and they shared co-corresponding authorship; all authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81770642; the Shanghai Association for Science and Technology, China, No. 19411951602.
Institutional review board statement: The study was reviewed and approved by the Shanghai Changhai Hospital Ethics Committee (CHEC No. 2019-081).
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Zhen-Dong Jin, MD, PhD, Director, Professor, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Yangpu District, Shanghai 200433, China.
Received: December 12, 2020
Peer-review started: December 12, 2020
First decision: December 17, 2020
Revised: December 30, 2020
Accepted: January 12, 2021
Article in press: January 12, 2021
Published online: February 14, 2021

Early detection of advanced cystic mucinous neoplasms [(A-cMNs), defined as high-grade dysplasia or malignancy] of the pancreas is of great significance. As a simple and feasible detection method, serum tumor markers (STMs) may be used to predict advanced intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs). However, there are few studies on the usefulness of STMs other than carbohydrate antigen (CA) 19-9 for early detection of A-cMNs.


To study the ability of five STMs-CA19-9, carcinoembryonic antigen (CEA), CA125, CA724, and CA242 to predict A-cMNs and distinguish IPMNs and MCNs.


We mainly measured the levels of each STM in patients pathologically diagnosed with cMNs. The mean levels of STMs and the number of A-cMN subjects with a higher STM level than the cutoff were compared respectively to identify the ability of STMs to predict A-cMNs and distinguish MCNs from IPMNs. A receiver operating characteristic curve with the area under curve (AUC) was also created to identify the performance of the five STMs.


A total of 187 patients with cMNs were identified and 72 of them showed A-cMNs. We found that CA19-9 exhibited the highest sensitivity (SE) (54.2%) and accuracy (76.5%) and a moderate ability (AUC = 0.766) to predict A-cMNs. In predicting high-grade dysplasia IPMNs, the SE of CA19-9 decreased to 38.5%. The ability of CEA, CA125, and CA724 to predict A-cMNs was low (AUC = 0.651, 0.583, and 0.618, respectively). The predictive ability of CA242 was not identified. The combination of STMs improved the SE to 62.5%. CA125 may be specific to the diagnosis of advanced MCNs.


CA19-9 has a moderate ability, and CEA, CA125, and CA724 have a low ability to predict A-cMNs. The combination of STM testing could improve SE in predicting A-cMNs.

Keywords: Serum tumor markers, Diagnosis, Advanced cystic mucinous neoplasms, Mucinous cystic neoplasms, Intraductal papillary mucinous neoplasms

Core Tip: The value of serum tumor markers (STMs) in predicting advanced cystic mucinous neoplasms (A-cMNs) has not been well studied except for carbohydrate antigen (CA) 19-9. Our study illustrates for the first time the potential value of multiple STMs in the diagnosis of A-cMNs. CA19-9 was the most accurate STM in predicting A-cMNs with a moderate ability. CEA, CA125, and CA724 showed a low ability to predict A-cMNs. CA125 may be specific to the diagnosis of advanced mucinous cystic neoplasms. CA242 was not identified as a useful STM in predicting A-cMNs in our study. The combination of STMs could improve sensitivity in predicting A-cMNs.