Prognostic Impact of Perioperative Serum CA 19-9 Levels in Patients with Resectable Pancreatic Cancer

Abstract

Postoperative CA19-9 level is a better prognostic factor than preoperative CA19-9 level, and curative surgery for resectable pancreatic cancer should be tried regardless of the preoperative CA19-9 level.

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

“…Overall, an elevated serum CA 19-9 level has a sensitivity of 79-81% and a specificity of 82-90% for diagnosing pancreatic cancer in symptomatic patients. The usefulness of pre-operative serum CA 19-9 levels to predict pancreatic cancer stage and determine resectability has been extensively studied [21][22][23][24][25][26] (Table 2). Kim et al evaluated CA 19-9 serum levels in 114 pancreatic cancer patients who underwent either pancreatic resection (N=72) or palliative bypass surgery (N=42).…”

“…Nevertheless, up to 15% of patients with pancreatic cancer are found unresectable at the time of surgery, which is attributable to occult vascular invasion, presence of undetected metastasis or positive peritoneal lavage cytology [25]. Whether preoperative CA 19-9 serum levels can serve as a surrogate marker for tumor resectability has been extensively evaluated [22,25,26,[29][30][31][32][33][34][35][36] (Table 3). Schleiman et al evaluated preoperative CA 19-9 serum levels in 89 pancreatic cancer patients prior to surgical exploration and noted that mean CA 19-9 serum levels were significantly lower in resectable tumors compared to those with locally advanced tumors (63 vs. 592 U/ml, p<0.003) or with metastatic disease (63 vs. 1,387 U/ml, p<0.001) [32] (Table 3).…”

“…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.…”

“…Kondo et al studied pre-and postoperative CA19-9 serum levels in 109 surgically treated pancreatic cancer patients and identified that both a normal postoperative CA 19-9 serum level (37 U/ml) (Hazard Ratio (HR) 1.64, p<0.004), and the addition of adjuvant chemotherapy were an independent predictors of prognosis [26]. More specifically these authors identified that a post-operative CA 19-9 serum level measured at 2-5 weeks could independently predict a prolonged 3-year survival rate (%).…”