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Correlative Study on Expression of CA 19-9 and DU-PAN-2 in Tumor Tissue and in Serum of Pancreatic Cancer Patients¹

The Eppley Institute for Research in Cancer and Allied Diseases [H. T., P. M. P.], Department of Internal Medicine [M. A. T., D. A. B.], and Department of Pathology and Microbiology [P. M. P.], University of Nebraska Medical Center, Omaha, Nebraska; The First Department of Surgery, Nippon Medical School, Tokyo, Japan [E. U.]; and Department of Microbiology and Immunology, Duke University Medical Center, Durham, North Carolina [R. S. M.]

The serum levels of CA 19-9 and DU-PAN-2 antigens and their expression in tumor tissue were examined in 22 pancreatic cancer patients and the results were correlated with the Lewis (Le) blood group phenotypes of the individuals. In tumor tissue, CA 19-9 was expressed in 17 of 22 (77%) specimens. The negative cases included three patients with Le^a-b-, one with Le^a+b- and the other with Le^a-b+ phenotypes. DU-PAN-2 antigen was expressed in 20 of 22 (91%) cancer tissues. The two DU-PAN-2-negative cases were CA 19-9-positive. The combination of two markers increased the sensitivity to 100%.

In the serum, CA 19-9 level was elevated (>37 U/ml) in 16 of 21 (73%) cases. All Le^a-b- patients had values <37 U/ml. An elevated level of DU-PAN-2 (>300 U/ml) was detected in 14 of 21 (67%) patients including three cases with Le^a-b- type. In only one patient were both antigens below the cutoff levels so that the combination of two biomarkers elevated the sensitivity to 95%. The study indicated that the cocktail of 19-9 and DU-PAN-2 antibodies might increase the sensitivity and specificity for clinical diagnosis of pancreatic cancer.

In 19 of 21 (90%) cases, the serum CA 19-9 level correlated with the expression of the antigen in the cancer tissue. Discrepancy was seen in two cases; one patient had an elevated level of CA 19-9 in the serum, but lacked this antigen in the cancer cells. In the second case, the situation was reversed. For DU-PAN-2, positive correlation was seen in 14 of 21 (67%) cases. Six of seven patients with low DU-PAN-2 levels expressed the antigen in their tumor cells, and one patient with DU-PAN-2-negative cancer tissue had an elevated level of this marker in the serum. Thus, CA 19-9 expression in serum corresponded more closely to expression in tissue than did that of DU-PAN-2 antigen. The serum levels of these antigens, however, is likely due to multiple factors, only one of which is the qualitative and quantitative expression of the antigens in tumors.

¹ This study was supported by Grant IM-472 from the American Cancer Society and by Grants CA 32672 and CA 36727 from the National Cancer Institute.

² To whom requests for reprints should be addressed, at The Eppley Institute for Research in Cancer, University of Nebraska Medical Center, 42nd and Dewey Avenue, Omaha, NE 68105.

Received 7/21/87. Revised 12/ 5/87. Accepted 12/14/87.