Serum CA125 is a novel predictive marker for pancreatic cancer metastasis and correlates with the metastasis-associated burden

// Liang Liu 1, 2, 3, * , Hua-Xiang Xu 1, 2, 3, * , Wen-Quan Wang 1, 2, 3, * , Chun-Tao Wu 1, 2, 3, * , Jin-Feng Xiang 1, 2, 3 , Chen Liu 1, 2, 3 , Jiang Long 1, 2, 3 , Jin Xu 1, 2, 3 , De-Liang Fu 4, * , Quan-Xing Ni 1, 2, 3 , Courtney W. Houchen 5 , Russell G. Postier 6 , Min Li 5, 6 , Xian-Jun Yu 1, 2, 3 1 Department of Pancreatic Surgery, Fudan University, Shanghai Cancer Center, Shanghai 20032, P.R. China 2 Pancreatic Cancer Institute, Fudan University, Shanghai 200032, P.R. China 3 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China 4 Department of Pancreatic Surgery, Huashan Hospital, Shanghai 200040, P.R. China 5 Department of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA 6 Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA * These authors have contributed equally to this work Correspondence to: Xian-Jun Yu, e-mail: yuxianjun@fudanpci.org ; yuxianjun@fudan.edu.cn Keywords: serum CA125, metastasis, prognosis, pancreatic cancer Received: May 30, 2015      Accepted: December 29, 2015      Published: January 5, 2016 ABSTRACT This study evaluated potential of serum tumor markers to predict the incidence and intensity of pancreatic cancer metastasis as well as patient survival. Retrospective records from 905 patients and prospective data from 142 patients were collected from two high-volume institutions. The levels of eight serum tumor markers (CA19-9, CEA, CA242, CA72-4, CA50, CA125, CA153, and AFP) commonly used in gastroenterological cancer were analyzed in all stages of pancreatic cancer. Serum CA125 levels were the most strongly associated with pancreatic cancer metastasis and were higher in patients with metastatic disease than those without. CA125 levels increased with increasing metastasis to lymph nodes and distant organs, especially the liver. High baseline CA125 levels predicted early distant metastasis after pancreatectomy and were associated with the presence of occult metastasis before surgery. An optimal CA125 cut-off value of 18.4 U/mL was identified; patients with baseline CA125 levels of 18.4 U/mL or higher had poor surgical outcomes. In addition, high serum CA125 levels coincided with the expression of a metastasis-associated gene signature and with alterations in “driver” gene expression involved in pancreatic cancer metastasis. CA125 may therefore be a promising, noninvasive, metastasis-associated biomarker for monitoring pancreatic cancer prognosis.