Clinical Significance Of Multiple Tumor Markers Combined Detection In The Diagnosis Of Pancreatic Cancer

Purpose:To study the clinical significance of multiple tumor markers including carbohydrate antigen199(CA199),carcinoembryonic antigen(CEA),carbohydrate antigen242(CA242),and carbohydrate antigen72-4(CA72-4)in the diagnosis of pancreatic cancer.Method:Eligible patients with pancreatic malignant tumor and patients with pancreatic benign disease admitted to the outpatient and inpatient Departments of the Second Norman Bethune Hospital of Jilin University from November 2014 to November2022 were selected as research objects.Epi Calc 2000 and SPSS 26.0 softwares were used to compare the basic clinical data and the level of tumor markers,and different markers were selected for logistic regression.Epi Calc 2000 and SPSS 26.0 softwares were then used to analyze sensitivity,specificity,positive predictive value,negative predictive value,Youden index,truncation value,and to compare the Area Under Curve(AUC)of Receiver Operating Characteristic(ROC)curve,using R 4.2.2 and R Studio softwares for Decision curve analysis(DCA)and Clinical impact curve(CIC)analysis.Results:1.Comparison of tumor markersThe levels of CA199,CEA,CA242 and CA72-4 in pancreatic cancer group were higher than those in control group(P<0.05).The positive rates of CA199,CEA and CA242 in pancreatic cancer group were higher than those in control group(P<0.05),but there was no significant difference in the positive rates of CA72-4(P>0.05).There were no significant differences in CA199,CEA,CA242 and CA72-4 levels among patients with different gender,age(≥60 years old or not)and symptoms(abdominal discomfort,jaundice)(P>0.05).The levels of CA199,CEA and CA242 in early patients were higher than those in late patients(P<0.05),but there was no significant difference in the level of CA72-4(P>0.05).2.Comparison of diagnostic efficacy and threshold probability of single indexAmong the single indexes,CA199 had the largest Youden index(0.70).The ROC-AUC of CA199 was the largest(0.897).The net benefit of CA199 decision curve was higher than other single indexes in all threshold probability range(0-1).In the clinical impact curve of single index,the threshold probability range of CA199 close to the real positive number of persons was the largest(0.6-1),and the cost/benefit ratio range was the largest(>4:3).3.Comparison of diagnostic efficacy and threshold probability of CA199,CEA and CA242 combined diagnosisIn combination diagnosis,the Youden index of CA199+CEA+CA242 was the highest(0.84).The ROC-AUC of CA199+CEA+CA242 was the largest,which was0.958.The net benefit of the decision curve of CA199+CEA+CA242 was higher than that of other combined diagnoses in all threshold probability ranges(0-1).In the clinical impact curve of combined diagnosis,the threshold probability range of CA199+CEA+CA242 close to the real positive number of persons was the largest(0.45-1),and the largest cost/benefit ratio range(>11:20).Conclusions:1.The levels of CA199,CEA,CA242 and CA72-4 in patients with pancreatic cancer were higher than those in patients with benign pancreatic disease,and the levels of CA199,CEA and CA242 in patients with metastatic and advanced pancreatic cancer were higher than those in patients with non-metastatic and early pancreatic cancer.2.Among the single indexes,CA199 had the best diagnostic efficacy.3.Among the single indexes,CA199 had the widest threshold probability range of high net benefit and close to the real positive number of persons.4.In combination diagnosis,CA199+CEA+CA242 had the best diagnostic efficacy.5.In combination diagnosis,CA199+CEA+CA242 had the widest range of high net benefit and threshold probability close to the real positive number of persons.