CA 19-9 and CEA in Prognosis of Duodenal Adenocarcinoma: A Retrospective Study


“To our knowledge, there are no studies evaluating the prognostic importance of CEA and Ca 19-9 in patients with DA [duodenal adenocarcinoma].”


BUFFALO, NY- April 18, 2023 – A new research paper was published in Oncotarget's Volume 14 on April 15, 2023, entitled, “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.”


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.


In this new study, researchers Ellery Altshuler, Raymond Richhart, William King, Mahmoud Aryan, Akash Mathavan, Akshay Mathavan, Keegan Hones, Daniel Leech, Logan Pucci, Joshua Riklan, Pat Haley, Ilyas Sahin, Brian Ramnaraign, Sherise Rogers, Ibrahim Nassour, Steven Hughes, Thomas J. George, and Jesus Fabregas from the University of Florida, University of Florida Health Cancer Center and University of Alabama at Birmingham conducted a single-institution retrospective review including patients diagnosed with biopsy-confirmed adenocarcinoma of the duodenum between 2006 and 2021. 


“To our knowledge, this is the first study to evaluate the role of tumor markers in patients with DA. In fact, this is the largest single institution study in the US evaluating this disease.”


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.


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).


“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.”


Read the full research paper: DOI: https://doi.org/10.18632/oncotarget.28406


Correspondence to: Ellery Altshuler


Email: [email protected] 


Keywords: duodenal adenocarcinoma, carbohydrate antigen, CA 19-9, carcinoembrionic antigen, CEA



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