Predictive Factors for Elevated Postoperative Carbohydrate Antigen 19-9 Levels in Patients With Resected Pancreatic Cancer

Abstract

Aim: In this study, we investigated the clinical significance of postoperative serum carbohydrate antigen (CA) 19-9 in patients with pancreatic ductal carcinoma (PDAC). Patients and Methods: A series of 116 patients with macroscopically curative PDAC resection was retrospectively evaluated. The cut-off level for elevated postoperative CA 19-9 was 37 U/ml. Results: Patients with high postoperative CA19-9 levels had a significantly poorer prognosis than patients with normal postoperative CA19-9 levels, as revealed by the logrank test. Multivariate analysis identified R1 resection and preoperative serum CA19-9 level ≥400 U/ml independently predicted elevated postoperative CA 19-9 levels. R1 resection and preoperative serum CA19-9 ≥400 U/ml were significantly associated with the recurrence of peritoneal dissemination and hepatic metastasis, respectively, within one year of operation. Conclusion: Elevated postoperative serum CA 19-9 level was associated with a poor prognosis and reflected positive resection margins and high preoperative CA 19-9 levels, which indicated presence of occult distant metastasis in patients with PDAC.Pancreatic ductal adenocarcinoma (PDAC) is highly lethal, and surgical resection is the only curative treatment available. The 5-year survival of patients with curative resection of PDAC has been estimated to be 20% (1). Adjuvant and neoadjuvant chemotherapies are offered in clinical practice aiming to improve survival (2-6). Accurate prediction of prognosis and effective stratification are important for planning postsurgical treatment and designing clinical trials. The prognostic value of carbohydrate antigen (CA) 19-9 has been evaluated in patients with PDAC following curative resection, and it reportedly reflects tumor burden (7, 8). High postoperative serum (Post)-CA 19-9 levels have been reported as a prognostic factor, and elevated Post-CA 19-9 levels were reported to be a more powerful prognostic factor than preoperative serum (Pre)-CA 19-9 (9-11) level. High Post-CA 19-9 levels have been considered to be associated with microscopically positive surgical margin or occult distant metastasis; however, their relationship has not been adequately and statistically confirmed yet (10-12). In the present study, we aimed to investigate the clinical significance of elevated Post-CA 19-9 levels by analyzing which factors are predictive of elevated Post-CA 19-9 levels. Patients and MethodsPatient population and study design. This retrospective cohort study evaluated patient data collected at the Tochigi Cancer Center. The protocol for this research project has been approved by a suitably constituted Ethics Committee of the institution and it conforms to the provisions of the Declaration of Helsinki.A series of 166 patients with surgical resection for PDAC between January 2008 and December 2016 were included in the analysis. Eleven patients with macroscopically positive resection margin or distant metastasis were excluded. Further, Pre-CA 19-9 was measured within 6 weeks of surgery. The lowest serum ...

Development and validation of a novel nomogram for predicting the prognosis of patients with resected pancreatic adenocarcinoma

“…Evaluation of preoperative CA199 is positively associated with tumor resectability and postoperative prognosis (14,16,44,45). Furthermore, postoperative CA199 levels have been reported to predict OS and disease-free survival following cancer resection and adjuvant chemotherapy (45)(46)(47)(48)(49). Consistent with the results from the present study, a previous report demonstrated that CA199 can predict the prognosis of patients with resected pancreatic adenocarcinoma when combined with PLR (45).…”

Characteristics of mass-forming autoimmune pancreatitis commonly misdiagnosed as a malignant tumor

“…CA19-9 is the most effective indicator for the diagnosis and follow-up of patients with pancreatic cancer ( 38 ). A CA19-9 level > 150 U/ml is highly correlated to pancreatic cancer ( 39 ).…”

“…ROC analysis showed that the AUC of IgG4 level before treatment, Tbil level before treatment, IgG4/Tbil before treatment, a combination of IgG4 and Tbil before treatment, and combination of IgG4, Tbil, and IgG4/Tbil before treatment was 0.915, 0.707, 0.919, 0.921, and 0.924, respectively (Figure 1, Table 3), indicating that all of these indicators had a high diagnostic value for AIP, among which the combination of IgG4, Tbil, and IgG4/Tbil before treatment had the highest diagnostic value. CA19-9 is the most effective indicator for the diagnosis and follow-up of patients with pancreatic cancer (38). A CA19-9 level > 150 U/ml is highly correlated to pancreatic cancer (39).…”

Pancreatic ductal adenocarcinoma with synchronous and metachronous hepatic metastasis predicted by contrast-enhanced ultrasound

“…CA19-9 is the only peripheral blood-based biomarker used to diagnose PDAC, but some studies (26,27) have concluded that this marker is not tumor-specific and is not suitable as a diagnostic biomarker for early metastases. However, some studies (28)(29)(30) have shown a possible correlation between CA19-9 ≥400 U/mL and hepatic metastasis. Meanwhile, other studies (27,31,32) have shown that the presence of circulating tumor cells (CTCs) in portal blood is associated with a higher rate of liver metastasis after resection of the primary tumor.…”