Clinical diagnostic value of serum CEA and CA19–9 in patients with advanced pancreatic cancer: A prognostic cohort study

Objective To evaluate the clinical diagnostic value of serum tumor markers (CEA and CA19‑9) and other blood‑based indicators in patients with advanced pancreatic cancer, and to assess their prognostic significance. Methods A retrospective analysis of 136 patients with advanced pancreatic cancer was conducted. Preoperative blood test results and peripheral immune cell counts, clinical characteristics, and survival data were collected. Univariate and multivariate Cox regression analyses were performed, and overall survival (OS) was assessed using the Kaplan–Meier method. Results ROC analysis showed good diagnostic accuracy for CA19‑9 (AUC = 0.886; optimal cutoff 37.44 U/mL) and CEA (AUC = 0.858; optimal cutoff 7.16 ng/mL). During follow‑up, 98 deaths occurred. Univariate analysis identified lymph node metastasis, elevated LDH, ALP, CA19‑9, CEA, CA125, CRP, NLR, and decreased LMR and albumin as significant risk factors for OS. Multivariate analysis revealed that elevated CA19‑9 (HR = 2.059, 95% CI: 1.185–3.576, P = 0.010) was an independent risk factor for survival, whereas CEA was not (HR = 1.309, P = 0.266). No significant differences were observed between CA19‑9 groups in tumor stage or metastasis (all P > 0.05), except for a borderline difference in tumor size ( P = 0.078). For CEA groups, no clinicopathological variable differed significantly (all P > 0.05). Kaplan–Meier analysis showed significantly lower OS in patients with CA19‑9 ≥ 37.44 U/mL or CEA ≥ 7.16 ng/mL (log‑rank P = 0.0004 and P = 0.006, respectively). Conclusions Preoperative serum CA19‑9 is an independent prognostic factor and a valuable diagnostic biomarker in advanced pancreatic cancer. CEA shows diagnostic potential but is not an independent prognostic factor after adjusting for CA19‑9.