Pretreatment CA 19-9 Level as a Prognostic Factor in Patients with Advanced Pancreatic Cancer Treated with Gemcitabine

Abstract

CA 19-9 may be a useful adjunct to response evaluation is this setting. In addition to CA 19-9 responses, prechemotherapy levels of this marker seem to have strong prognostic significance.

Serum CA19-9 response as a surrogate for clinical outcome in patients receiving fixed-dose rate gemcitabine for advanced pancreatic cancer

“…A small retrospective study by Saad et al (2002) of 28 patients with advanced pancreatic cancer treated with gemcitabine found that lower pretreatment levels of CA19-9, as well as a X50% decline in CA19-9 anytime during treatment, correlated with better survival rates. Halm et al (2000) examined 43 unresectable patients receiving gemcitabine treatment and found that those with a 420% decrease of their baseline CA19-9 level after 8 weeks of treatment had a longer median survival than those with a rise or a decrease o20% (268 vs 110 days), a finding confirmed by Ziske et al (2003).…”

Serum CA 19-9 as a Biomarker for Pancreatic Cancer—A Comprehensive Review

“…Whether serum CA 19-9 levels can be used as a surrogate marker of response to chemotherapy has been studied in a variety of clinical settings [41,44,[53][54][55][56][57][58][59][60][61][62][63][64]. Willett et al measured CA 19-9 serum levels in 42 resectable pancreatic cancer patients receiving neoadjuvant treatment with 5-flourouracil and external beam radiation prior to planned pancreaticoduodenectomy.…”

“…Nearly all studies have demonstrated that a treatment related decline in CA 19-9 serum levels is associated with prolonged survival and is an independent predictor of overall survival [41,44,[53][54][55][56][57][58][59][60][61][62][63][64] (Table 5). Reni et al compared basal CA 19-9 serum levels in 247 advanced pancreatic cancer patients enrolled in five consecutive chemotherapy trials (G, gemcitabine; PEFG, cisplatin, epirubicin, 5-fluorouracil, and gemcitabine; PDXG, cisplatin, docetaxel, capecitabine, and gemcitabine) [60].…”

“…In summary, these studies suggest that a median CA 19-9 serum level <100 U/ml correlates with resectability (41-80%) whereas levels >100 U/ml suggest advanced or metastatic pancreatic cancer (60-85%) (Table 3). The utility of serum CA 19-9 levels to provide meaningful prognostic information and permit patient stratification (survival groups) based on CA 19-9 serum level has been extensively evaluated [22,24,26,30,31,[36][37][38][39][40][41][42][43][44][45][46][47][48][49] (Table 4). Waraya et al performed a multivariate analysis of factors predicting survival in 117 pancreatic cancer patients undergoing surgical resection and reported that a low preoperative CA 19-9 serum levels (28-30 U/ml) (p<0.0016, relative risk (RR), 2.16) and positive peripancreatic margin (p<0.04, RR, 1.62) independently predicted survival [46].…”

“…U/ml unit/milliliter, SD standard deviation, NA not available, R0 resection-microscopic margin tumor free, R1 resection-microscopic margins positive for tumor, R2 resection-macroscopic tumor left behind Author, Year N= CA 19-9 cut-off levels (U/ml) Median survival (months) 4 months in patients with a preoperative CA19-9 level >150 U/ml (N=64), compared to a median survival of 22.1 months in patients with a CA19-9 serum level ≤150 U/ml (N=45, p<0.012) [45]. Table 3 lists additional studies which have used various cut-off levels for pre-operative CA 19-9 serum levels in an effort to predict survival among pancreatic cancer patients [22,24,26,30,31,[36][37][38][39][40][41][42][43][44][45][46][47][48][49]. These studies support the conclusion that a normal (<37 U/ml) or low preoperative CA 19-9 serum level (<100 U/ml) correlates with early pancreatic cancer stage and independently predicts improved overall survival, whereas an elevated CA 19-9 serum levels (>100 U/ml) is associated with a poor prognosis.…”