Importance of carbohydrate antigen (CA 19-9) and carcinoembrionic antigen (CEA) in the prognosis of patients with duodenal adenocarcinoma: a retrospective single-institution cohort study
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Ellery Altshuler1, Raymond Richhart1, William King1, Mahmoud Aryan2, Akash Mathavan3, Akshay Mathavan3, Keegan Hones3, Daniel F. Leach III3,7, Logan Pucci1, Joshua Riklan1, Pat Haley1, Ilyas Sahin4,5, Brian Ramnaraign4,5, Sherise Rogers4,5, Ibrahim Nassour6, Steven Hughes6, Thomas J. George4,5 and Jesus Fabregas4,5
1 Department of Internal Medicine, University of Florida, Gainesville, FL 32610, USA
2 Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
3 University of Florida College of Medicine, Gainesville, FL 32610, USA
4 Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
5 University of Florida Health Cancer Center, Gainesville, FL 32610, USA
6 Division of Surgical Oncology, Department of Surgery, University of Florida, Gainesville, FL 32610, USA
7 Department of Radiation Oncology, University of Florida Health, Gainesville, FL 32601, USA
|Ellery Altshuler,||email:||[email protected]|
Keywords: duodenal adenocarcinoma; carbohydrate antigen; CA 19-9; carcinoembrionic antigen; CEA
Abbreviations: DA: duodenal adenocarcinoma; CEA: carcinoembryonic antigen; CA: carbohydrate antigen
Received: October 10, 2022 Accepted: March 21, 2023 Published: April 15, 2023
Background: Duodenal adenocarcinoma (DA) is a rare malignancy without validated tumor markers. In practice, carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9) are often used in the management of DA, though their prognostic value is unknown.
Materials and Methods: A single-institution retrospective review included patients diagnosed with biopsy-confirmed adenocarcinoma of the duodenum between 2006 and 2021. Peri-ampullary tumors were excluded. Levels of CA 19-9 and CEA were collected as continuous variables and were analyzed as binary variables: normal vs. high, using the maximum normal value as a cut-off (normal Ca 19-9 <35 U/ml; CEA <3 ng/ml). Survival analysis was conducted using Kaplan Meier curves, log-rank test and Cox proportional hazards model.
Results: There were 68 patients included in the final analysis. Median age was 67 years old and median follow-up time was 22.2 months. CA 19-9 and CEA were elevated in 36.8% and 48.5% of patients, respectively. A concomitant elevation of both tumor markers was associated with worsened OS (HR 2.140, 95% CI: 1.114–4.112; p = 0.019). After controlling for age and sex on multivariate analysis, elevation in both CA 19-9 ≥35 and CEA ≥3.0 remained significantly associated with increased mortality (HR 2.278, 95% CI: 1.162–4.466; p = 0.016).
Conclusions: In summary, CA 19-9 and, to a lesser extent, CEA, show promise as prognostic markers in DA. Larger studies are needed to validate their use and to evaluate their performance as markers of recurrence.
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