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
Research background

Early detection of advanced cystic mucinous neoplasms (A-cMNs) of the pancreas is key to the management of pancreatic cystic lesions (PCLs) in relation to the carcinogenic potential of cMNs. However, the long-term, routine yearly surveillance by imaging methods recommended by the current guidelines will impose heavy psychological and economic burdens on patients.

Research motivation

As an economical and feasible detection method, serum tumor markers (STMs) can be obtained during ordinary health checkups. However, the role of STMs in predicting advanced PCLs remains elusive. In view of the consistency between the increasing level of STMs and tumor progression, STM detection may play an important role in the early diagnosis of advanced PCLs.

Research objectives

This study aimed to evaluate the ability of five common serum tumor markers to predict A-cMNs separately and in combination. The relevant research results may be beneficial to the management of PCLs and the optimization of guidance or consensus.

Research methods

This retrospective cohort study mainly measured the levels of serum carbohydrate antigen (CA) 19-9, carcinoembryonic antigen (CEA), CA125, CA724, and CA242 in patients pathologically diagnosed with cMNs to identify the ability of these STMs to predict A-cMNs and distinguish mucinous cystic neoplasms (MCNs) from intraductal papillary mucinous neoplasms. A receiver operating characteristic curve with an area under curve and the sensitivity (SE), specificity (SP), and accuracy were also created to identify the performance of the five STMs.

Research results

CA19-9 showed the highest SE and accuracy and a moderate ability to predict A-cMNs. The ability of CEA, CA125, and CA724 to predict A-cMNs was low. The predictive ability of CA242 was not identified. A combination of STMs could improve SE. CA125 was more likely a predictor of advanced MCNs than advanced intraductal papillary mucinous neoplasms.

Research conclusions

CA19-9 showed a moderate ability, and CEA, CA125, and CA724 showed a low ability to predict A-cMNs. Detection of multiple STMs could improve SE in predicting A-cMNs, which has great potential to improve the early diagnosis rate of advanced PCLs in clinical practice. CA125 may be specific to the diagnosis of advanced MCNs and can be used as a reminder for physicians not to ignore pancreatic examination in patients with elevated CA125.

Research perspectives

A multicenter prospective study that monitors PCL patients with detailed data on serum tumor markers should be performed.