Elevated serum CA19-9 level is a promising predictor for poor prognosis in patients with resectable pancreatic ductal adenocarcinoma: a pilot study

Abstract

BackgroundPancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive human cancers. Several studies have reported that the carbohydrate antigen 19-9 (CA19-9) level is a useful marker for predicting the prognosis for PDAC after resection. However, the cutoff value of CA19-9 used to predict prognosis varied among these reports. The aims of this study were to evaluate whether the serum CA19-9 level is a significant predictor for survival and to determine the optimal cutoff value of CA19-9 for predicting prognosis.MethodsA total of 120 consecutive patients who underwent surgery for potentially resectable primary PDAC were retrospectively analyzed. The variables included the following: age, sex, the location of the tumor, the maximal tumor size, the histological differentiation, the margin status, the tumor stage, serum CA19-9 levels, and serum total bilirubin (TBil) levels.ResultsThe overall 1-year survival rate was 62.5%. The receiver operating characteristic (ROC) curve indicated a significant result for the level of CA19-9 in predicting death within 1 year after surgery (Area under the curve (AUC), 0.612; 95% confidence interval (CI), 0.505-0.720; P = 0.040). The optimal cutoff point was 338.45 U/mL (sensitivity, 60.0%; specificity, 66.7%; accuracy, 64.2%). The strongest univariate predictor among the categorized CA19-9 values was CA19-9 greater than or equal to 338.45 U/mL. In the multivariate Cox proportional hazards mode analysis, the serum CA19-9 level, age and the histological differentiation were significant independent prognostic factors that were associated with the overall survival.ConclusionsThe preoperative elevated CA19-9 level is a promising independent factor for predicting a poor prognosis in PDAC, and the optimal cutoff value is 338.45 U/mL.

High expression of GFAT1 predicts poor prognosis in patients with pancreatic cancer

“…Traditional predictive models for patients have limited capacity to determine different outcomes of pancreatic cancer. Carbohydrate antigen19–9 (CA 19–9) has been considered as a prognostic factor for pancreatic cancer, whereas the prognostic value of CA19–9 is still controversial1213. Other pathologic prognostic factors, such as TNM classification systems, tumor size and lymph node (LN) metastasis, ignores the underlying molecular and cellular processes during the carcinogenesis of pancreatic cancer.…”

Surgical Margin Status of Patients with Pancreatic Ductal Adenocarcinoma Undergoing Surgery with Radical Intent: Risk Factors for the Survival Impact of Positive Margins

“…Based on our receiver operating characteristics curve analysis, the optimal cutoff value of CA19-9 for prediction of positive surgical margins was 246 U/ml. CA19-9 has been reported to be a useful biochemical marker for diagnosing pancreatic cancer (9) and a predictor of overall survival for patients with resectable PDAC (10). Therefore, CA19-9 should be regarded as a predictive marker for positive surgical margins that has versatile clinical applications.…”

Tumor copy number instability is a significant predictor for late recurrence after radical surgery of pancreatic ductal adenocarcinoma

“…Clinical and laboratory features, such as LN metastasis, preoperative CA19-9, pathological stage, tumor size, and age, have been reported to be associated with recurrence in PDAC. 6,17,20,21 Herein, univariate and multivariable logistic regression analyses were performed to assess whether the following characteristics were risk factors for LR: age, gender, pathological stage, T status, LN metastasis status, tumor size, preoperative CA19-9, and preoperative carcinoembryonic antigen (CEA). Univariate analysis demonstrated T status, LN metastasis status, and CNI as considerable risk factors for LR (P < .050, Table 3).…”

“…6,[10][11][12][13] Serum carbohydrate antigen 19-9 (CA19-9) is a well-known preoperative and postoperative predictor of clinical outcomes in PDAC. [14][15][16][17] However, the evaluation of patient prognosis mainly relies on pathological features and serum tumor markers. In addition to the four major driver genes (KRAS, CDKN2A, TP53, and SMAD4), few established genomic features have been reported as postoperative predictive markers of outcomes in PDAC.…”