Clinical usefulness of CA-19-9 in pancreatic carcinoma

Abstract

Preoperative and postoperative serum levels of carbohydrate antigen‐(CA)19‐9 in 148 patients with carcinoma of the pancreas were studied. All 18 patients with carcinoma of the pancreas of Stage I, II, and III were resectable, and their pre‐operative serum levels of CA‐19‐9 were under 1,344 U/ml. Pre‐operative serum levels of CA‐19‐9 in patients with Stage IV ranged widely between 5 and 32,240 U/ml. The postoperative survival rate was significantly superior in patients (n = 15) whose CA‐19‐9 pre‐operative serum levels were less than 2,000 U/ml compare to those (n = 64) whose levels were over that level. Fifteen resectable patients who showed serum levels of CA‐19‐9 over 2,000 U/ml pre‐operatively died within 2 years postoperatively due to recurrence, especially by liver metastasis in spite of aggressive surgery. Intraoperative quick immunostaining of CA‐19‐9 and carcinoembryonic antigen (CEA) was useful to diagnose intrapancreatic carcinoma development on frozen sections of cut margin of the pancreas and also useful in abdominal washing cytology combined with conventional staining. Semin. Surg. Oncol. 15:15–22, 1998. © 1998 Wiley‐Liss, Inc.

Very High Serum CA 19-9 Levels: A Contraindication to Pancreaticoduodenectomy?

“…22 Our study confirmed that elevated serum CA 19-9 level correlates with a poor survival as corroborated by several studies. [8][9][10][11][12][13][14][15][16][17]23 Our study also found that patients with VHL (over 800 IU/ml) had equivalent survival as patients with HL. Thus, although a serum CA 19-9 level of 150 or 300 IU/ml preoperatively may discriminate between patients with good and poor outcome, 5, 12-14, 16 levels over 400 IU/ml, however high, have no additional effect on survival.…”

“…12 Moreover, some investigators have found that elevated preoperative serum CA 19-9 levels are significantly associated with tumor unresectability, although the cut-off levels reported range from 100 to 350 IU/ml. [8][9][10][11][12][13][14][15][16][17] Based on these data, some speculate that preoperative staging of a potentially resectable PA should routinely include serum CA 19-9 levels after biliary decompression. In the case where careful preoperative staging indicates a radiographically resectable PA without evidence of distant metastasis but the serum CA 19-9 levels are highly elevated, the staging might be better clarified by the use of laparoscopy.…”

“…On the other hand, the cut-off in this study was 180 IU/ml and very few patients with high serum CA 19-9 levels (>400 IU/ml) were enrolled. Nakao et al 17 published over 10 years ago a report of 15 resected patients with serum CA 19-9 levels >2,000 IU/ml. These patients had a median survival of 6 months and were all dead after 19 months of follow-up.…”

“…[5][6][7] Several reports have shown that a serum CA19-9 level above 200 or 300 IU/ml correlates with poor outcome and conclude that such patients will likely not benefit from surgery. [8][9][10][11][12][13][14][15][16][17] A minority of patients with resectable PA have high levels (>400 IU/ml) of serum CA19-9. Even when patients with high serum CA 19-9 are determined to be radiographically resectable, they will often have metastasis discovered at the time of laparoscopy or laparotomy.…”

Predictive and Prognostic Value of CA 19-9 in Resected Pancreatic Adenocarcinoma

“…2,3 The relationship between increases in CA 19-9 and poor survival is well documented. [4][5][6][7] Numerous studies have shown that CA 19-9 is associated not only with resectability but also with tumor stage in pancreatic cancer. [8][9][10] In fact, Schlieman et al 8 suggested that an increased CA 19-9 level is predictive of unresectability at the time of exploration even when there is no evidence of unresectability on preoperative imaging studies.…”