The Diagnostic Value of the CA19-9 and Bilirubin Ratio in Patients with Pancreatic Cancer, Distal Bile Duct Cancer and Benign Periampullary Diseases, a Novel Approach

Lenka N.C. Boyd, Mahsoem Ali, Laura Kam, Jisce R. Puik, Stephanie M.Fraga Rodrigues, Eline S. Zwart, Freek Daams, Barbara M. Zonderhuis, Laura L. Meijer, Tessa Y.S. Le Large, Elisa Giovannetti*, Hanneke W.M. van Laarhoven, Geert Kazemier

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Distinction of pancreatic ductal adenocarcinoma (PDAC) in the head of the pancreas, distal cholangiocarcinoma (dCCA), and benign periampullary conditions, is complex as they often share similar clinical symptoms. However, these diseases require specific management strategies, urging improvement of non-invasive tools for accurate diagnosis. Recent evidence has shown that the ratio between CA19-9 and bilirubin levels supports diagnostic distinction of benign or malignant hepatopancreaticobiliary diseases. Here, we investigate the diagnostic value of this ratio in PDAC, dCCA and benign diseases of the periampullary region in a novel fashion. To address this aim, we enrolled 265 patients with hepatopancreaticobiliary diseases and constructed four logistic regression models on a subset of patients (n = 232) based on CA19-9, bilirubin and the ratio of both values: CA19-9/(bilirubin−1). Non-linearity was investigated using restricted cubic splines and a final model, the ‘Model Ratio’, based on these three variables was fitted using multivariable fractional polynomials. The performance of this model was consistently superior in terms of discrimination and calibration compared to models based on CA19-9 combined with bilirubin and CA19-9 or bilirubin alone. The ‘Model Ratio’ accurately distinguished between malignant and benign disease (AUC [95% CI], 0.91 [0.86–0.95]), PDAC and benign disease (AUC 0.91 [0.87–0.96]) and PDAC and dCCA (AUC 0.83 [0.74–0.92]) which was confirmed by internal validation using 1000 bootstrap replicates. These findings provide a foundation to improve minimally-invasive diagnostic procedures, ultimately ameliorating effective therapy for PDAC and dCCA.

Original languageEnglish
Article number344
JournalCancers
Volume14
Issue number2
DOIs
Publication statusPublished - 11 Jan 2022

Bibliographical note

Funding: This research was funded by the Bennink Foundation (E.G., G.K., L.L.M., T.Y.S.L.L., L.N.C.B.), Italian Association for Cancer Research AIRC/IG grant 24444, Italy (E.G.), Fondazione Pisana Per La Scienza, Italy (E.G.), and Dutch Cancer Society KWF grant 10401 (E.G., G.K.).

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.

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