Very High Serum CA 19-9 Levels: A Contraindication to Pancreaticoduodenectomy?

Abstract

Patients who normalized their CA19-9 levels postoperatively had equivalent survival to patients with normal preoperative CA 19-9 levels. Preoperative serum CA 19-9 level by itself should not preclude surgery in patients who have undergone careful preoperative staging.

Resection of Borderline Resectable and Locally Advanced Pancreatic Adenocarcinomas after Neoadjuvant Chemotherapy

“…Based on these findings, the authors recommended surgery in all patients with a BL tumor who at least did not progress while receiving preoperative treatment. It has been showed that CA 19-9 serum values can be predictive of the resectability status and overall survival in resectable and BL pancreatic cancer patients [24,25]. Two studies showed that in patients with BL pancreatic cancer treated with neoadjuvant chemotherapy, the failure to normalize CA 19-9 levels was an independent risk factor for lower overall survival after resection [7,26].…”

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

“…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.…”

Biomarkers in pancreatic adenocarcinoma: current perspectives

“…Numerous studies have demonstrated that elevated CA 19-9 levels are associated with worse stage-specific survival and recurrence 13,36–38. Postoperative CA 19-9 levels are thought to be a more accurate estimate of prognosis than those obtained prior to resection 36,37.…”