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Genotyping 615 patients showed that about one in ten cannot make CA 19-9, that their outlook is as poor as patients with very high readings, and that a value of 7 or below is a practical way to spot them without a genetic test.
Germline whole-exome sequencing in a multicentre cohort of 615 patients with pancreatic ductal adenocarcinoma determined FUT2 and FUT3 genotypes. Receiver operating characteristic analysis identified the optimal CA 19-9 cut-off for FUT3-null status and maximally selected rank statistics derived cut-offs stratifying overall survival in a training set (307) tested in a validation set (308). FUT3-null patients had similar demographics but a much lower median baseline CA 19-9 (2.4 against 496 U/mL) and a median overall survival of 13.5 months, comparable with FUT3-intact patients above 200 U/mL (12.9 months). A cut-off of 7 U/mL identified FUT3-null status with positive predictive value 95.1% and accuracy 87.9%. Using 7 and 200 U/mL without genotyping gave four prognostic groups: above 7 to 37 (23.2 months), above 37 to 200 (22 months), above 200 (12.8 months) and 7 or below, likely FUT3-null (13.5 months).
A very low CA 19-9 is not reassurance: it marks the non-producer group whose outlook matches the highest-marker group, and it gives clinics a rule they can apply without genotyping.
Shares CA 19-9, Pancreatic ductal adenocarcinoma.
Shares CA 19-9, Pancreatic ductal adenocarcinoma.
Shares Clinical Cancer Research, Pancreatic ductal adenocarcinoma.
Shares Clinical Cancer Research, Pancreatic ductal adenocarcinoma.
Shares CA 19-9, Pancreatic ductal adenocarcinoma.
Shares CA 19-9, Pancreatic ductal adenocarcinoma.
Shares Founder mutation (BRCA1 185delAG and 5382insC, BRCA2 6174delT), Germline (hereditary) testing.
Shares Clinical Cancer Research, Pancreatic ductal adenocarcinoma.