Background
While classical tumor markers such as CEA and CA19-9 are widely used in oncology, increasing evidence suggests they may also reflect systemic inflammation and metabolic stress relevant to cardiovascular disease. The potential prognostic role of such markers in patients with cardiovascular disease but absent of oncological diagnosis has not been systematically investigated.
Methods
We retrospectively analyzed 5,455 consecutive patients undergoing coronary catheterization at a tertiary care center between 2007 and 2017. Overlapping the data with the german cancer registry allowed us to identify all patients with the diagnosis of cancer (diagnosis included until 2024). Serum levels of CEA, CA19-9, CA125, and PSA were assessed together with hs-cTnT and NT-proBNP. The primary endpoint was all-cause mortality. Survival was evaluated by Kaplan–Meier analysis and Cox regression adjusting for age, cardiovascular risk factors, and cardiac biomarkers.
Results
Among 4,070 patients without known malignancy, lower levels of CEA (≤ 1.55 µg/L) and CA19-9 (≤ 12.95 U/mL) were associated with significantly higher long-term survival (log-rank p < 0.001 and p = 0.009, respectively). NT-proBNP > 300 ng/L and hs-cTnT > 14 pg/mL remained the strongest predictors of all-cause mortality (OR ≈ 2.5–3.2). In multivariate models adjusted for age, hypertension, and diabetes, CEA and CA19-9 showed modest but significant associations with mortality, while CA125 and PSA had no prognostic value. Age > 65 years emerged as an independent risk factor.
Conclusions
In cardiovascular patients without cancer, higher concentrations of CEA and CA19-9 were associated with increased long-term mortality, complementing established cardiac biomarkers such as NT-proBNP and hs-cTnT. These findings suggest that tumor markers may serve as additional indicators of systemic disease activity and mortality risk in cardiovascular populations, highlighting a potential diagnostic link between oncologic and cardiovascular pathways.
Keywords
CEA, CA19-9, tumor markers, cardiovascular disease, mortality, NT-proBNP, hs-cTnT, onco-cardiology, systemic inflammation, risk stratification
