Relationship Between CA 19.9 and the Lewis Phenotype: Options to Improve Diagnostic Efficiency

Abstract

Background/aim: Approximately 10% of patients are unable to synthesize CA 19.9 (Lewis-negative), and these results are erroneously considered false-negatives. The aim of this study was to confirm that CA 19.9 cannot be detected by immunoassays in Lewis-negative patients.

Materials and methods: CA 19.9 levels were measured by immunological assays and Lewis phenotype was determined by the haemagglutination reaction.

Results: Patients with Lewis phenotype (a+b-) or (a-b+) had significantly higher CA 19.9 levels than Lewis-negative patients with active cancer (p<0.001), no-evidence of disease (NED) patients (p<0.001) or patients with benign disease (p<0.001). Ninenty-four percent of patients (33/35) with undetectable CA 19.9 had a Lewis-negative phenotype. Additionally, 94.7% (34/36) of patients with Lewis-negative phenotypes had undetectable CA 19.9 serum levels.

Conclusion: Patients with undetectable CA 19.9 serum levels tend to be Lewis-negative, and CA 19.9 is not useful in diagnosis or follow-up.

Keywords: CA 19.9; Lewis; cholangiocarcinoma; false negative results; pancreatic cancer.