Serum HCGβ and CA 72-4 Are Stronger Prognostic Factors than CEA, CA 19-9 and CA 242 in Pancreatic Cancer

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Abstract
In pancreatic cancer, the extent of the spread of the disease is considered to be the strongest prognostic factor. In addition, tumor markers, particularly CA 19-9, may also provide prognostic information. In this study, we evaluated the prognostic value of serum tumor markers CEA, CA 19-9, CA 242, CA 72-4 and hCG beta in pancreatic cancer. Preoperative serum samples were obtained from 160 patients with pancreatic cancer, including 10 with stage I, 25 with stage II, 24 with stage III and 101 patients with stage IV cancer. Quantitation of CEA, CA 19-9, CA 242, and CA 72-4 in serum was performed with commercial assays. HCG beta was measured with an in-house immunofluorometric assay based on monoclonal antibodies specific for the free beta-subunit of hCG. Survival analysis was performed with univariate Kaplan-Meier life-tables and log-rank test, and with multivariate Cox regression analysis. Of the tumor markers studied, CA 19-9 was most frequently elevated. Overall 2-year survival was 10%. Stage, tumor location and size, curative resection, and CEA, CA 72-4 and hCG beta were all found to be prognostic factors (p < 0.026) in univariate analysis. In multivariate analysis, each marker had independent prognostic value (p < 0.011) when analyzed individually but adjusting for stage. When all the covariates were included in the same model, the strongest prognostic factor was hCG beta followed by CA 72-4 and stage. The other clinical characteristics and serum tumor markers contributed insignificant prognostic information. All the tumor markers studied (CEA, CA 19-9, CA 242, CA 72-4, and hCG beta) had prognostic value in pancreatic cancer, and hCG beta, CA 72-4, and stage were the strongest independent prognostic factors in this study.