CA19-9 PROGNOSTIC VALUE IN MALIGNANT TRANSFORMATION OF PANCREATIC CYSTIC LESIONS: A META-ANALYSIS shangmengge@gmail.com.

 

CA19-9 PROGNOSTIC VALUE IN MALIGNANT TRANSFORMATION OF PANCREATIC CYSTIC LESIONS: A META-ANALYSIS

2

Australia

Oral or Poster

Pancreatic cystic neoplasms (PCNs), including IPMNs and MCNs, are increasingly detected through routine imaging. Although many are benign, concerns over malignant transformation lead to surgical resection—yet up to 60% of these procedures reveal non-invasive disease. A reliable biomarker could reduce overtreatment and guide appropriate intervention. Serum carbohydrate antigen 19-9 (CA19-9), widely used in pancreatic adenocarcinoma, has been proposed as a prognostic tool in PCNs, but its accuracy remains debated.

A systematic search of MEDLINE, PubMed, and EMBASE identified studies published between January 2014 and February 2024 reporting histologically confirmed PCNs with sufficient data for 2×2 contingency tables. Data extraction and quality assessment were performed using Covidence and QUADAS-2. Meta-analysis was conducted in R using random-effects models

Twenty-seven studies were included. The pooled sensitivity of CA19-9 for detecting malignant transformation was 0.50 (95% CI: 0.44–0.57), and pooled specificity was 0.87 (95% CI: 0.85–0.89). Elevated CA19-9 levels were associated with a significantly increased risk of malignancy (RR: 2.67; 95% CI: 2.21–3.23), though substantial heterogeneity was observed (I² = 81%).

CA19-9 demonstrates high specificity but limited sensitivity in predicting malignant transformation of pancreatic cysts. Elevated levels are associated with increased malignancy risk, but variability across studies limits standalone use. CA19-9 should be interpreted alongside imaging and clinical features to optimize patient selection for surgery and reduce overtreatment.