The prognostic and predictive value of serum CA19.9 in pancreatic cancer

Abstract

BackgroundCurrent staging methods for pancreatic cancer (PC) are inadequate, and biomarkers to aid clinical decision making are lacking. Despite the availability of the serum marker carbohydrate antigen 19.9 (CA19.9) for over two decades, its precise role in the management of PC is yet to be defined, and as a consequence, it is not widely used.MethodsWe assessed the relationship between perioperative serum CA19.9 levels, survival and adjuvant chemotherapeutic responsiveness in a cohort of 260 patients who underwent operative resection for PC.ResultsBy specifically assessing the subgroup of patients with detectable CA19.9, we identified potential utility at key clinical decision points. Low postoperative CA19.9 at 3 months (median survival 25.6 vs 14.8 months, P = 0.0052) and before adjuvant chemotherapy were independent prognostic factors. Patients with postoperative CA 19.9 levels >90 U/ml did not benefit from adjuvant chemotherapy (P = 0.7194) compared with those with a CA19.9 of ≤90 U/ml (median 26.0 vs 16.7 months, P = 0.0108). Normalization of CA19.9 within 6 months of resection was also an independent favorable prognostic factor (median 29.9 vs 14.8 months, P = 0.0004) and normal perioperative CA19.9 levels identified a good prognostic group, which was associated with a 5-year survival of 42%.ConclusionsPerioperative serum CA19.9 measurements are informative in patients with detectable CA19.9 (defined by serum levels of >5 U/ml) and have potential clinical utility in predicting outcome and response to adjuvant chemotherapy. Future clinical trials should prioritize incorporation of CA19.9 measurement at key decision points to prospectively validate these findings and facilitate implementation.

Applicative Value of Serum CA19-9, CEA, CA125 and CA242 in Diagnosis and Prognosis for Patients with Pancreatic Cancer Treated by Concurrent Chemoradiotherapy

“…Humphris et al (Humphris et al, 2012) reported that CA19-9 is of significance to the diagnosis and prognosis of pancreatic cancer. Li et al (Li et al, 2014) suggested that CA19-9 and CA242 are independent prognostic factors for assessing the prognosis of pancreatic carcinoma.…”

Patients with normal-range CA19-9 levels represent a distinct subgroup of pancreatic cancer patients

“…1F) sp16. Discussion CA19-9 is the most important tumor marker in pancreatic cancer and is aberrantly secreted by the majority of pancreatic tumors (6,9,(11)(12)(13)(14)(15)17,18). However, a distinct subset of patients with pancreatic cancer present with normal serum CA19-9 levels and are occasionally Lewis antigen-positive.…”

“…It has been extensively used as a pancreatic cancer biomarker at various phases of pancreatic cancer management (6,8,9,(11)(12)(13). The recommended upper limit for normal serum CA19-9 expression is 37 U/ml, as determined by the standard deviation of CA19-9 expression in the normal population (11,12,14).…”

“…It has been extensively used as a pancreatic cancer biomarker at various phases of pancreatic cancer management (6,8,9,(11)(12)(13). The recommended upper limit for normal serum CA19-9 expression is 37 U/ml, as determined by the standard deviation of CA19-9 expression in the normal population (11,12,14). Several studies have demonstrated that early-and advanced-stage pancreatic cancer patients with normal serum CA19-9 expression (≤37 U/ml) had a significant survival advantage compared with patients with elevated serum CA19-9 expression (>37 U/ml) (11,14,15).…”

Prognostic value of inflammation-based markers in patients with pancreatic cancer administered gemcitabine and erlotinib

“…Gemcitabine-based combination therapy is considered an effective first-line treatment for advanced PC [4,[17][18][19] . While the tumor stage and the carbohydrate antigen 19-9 levels have been used to predict patients' prognoses [20][21][22] , predicting the therapeutic effect of or a patient's response to chemotherapy is difficult.…”