Exploring correlations of CA19-9 with serum enzyme ratios: can layered biomarker strategies enhance prognostic accuracy in pancreatic cancer?

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive cancers, with a poor prognosis and minimal response to treatment. Its late presentation, hazy symptoms, and sneaky onset make early diagnosis difficult, and its high recurrence rate reduces survival chances. There is an urgent need for reliable biomarkers and prognostic tools to guide therapeutic treatment.This study aims to evaluate the role that liver enzymes, serum biomarkers, and composite indices play in PDAC diagnosis, prognosis, and treatment. To improve predictive value, an emphasis will be on integrating serum carbohydrate antigen (CA19-9) with enzyme-based markers. A comprehensive assessment of recent research was carried out, with a focus on liver enzyme alterations, serum tumor markers, diagnostic modalities, and novel ratio-based and composite scoring systems. Although it is limited by false positives and Lewis antigen-negative status, the most widely used biomarker, CA19-9, is helpful for monitoring the burden of disease and the efficacy of treatment. Transaminases (AST/ALT), alkaline phosphatase (ALP), and γ-glutamyltransferase (GGT) are examples of serum enzymes with independent prognostic significance that reflect both tumor biology and systemic impact. AST/ALT and CA19-9/GGT are two examples of ratio-based indicators that outperform absolute levels and offer more precise survival classification. Lactate dehydrogenase (LDH), GGT, and systemic inflammatory markers (SII) are combined to create composite indices that guide clinical decision-making and prognosis. An integrated framework that integrates CA19-9, enzyme markers, and composite indicators provides a thorough approach to PDAC prognosis and management. These readily accessible, affordable, and non-invasive methods have the potential to improve risk prediction, optimize treatment strategies, and improve customized care for pancreatic cancer.