title: Biliary CA 19-9 values correlate with the risk of hepatic metastases in patients with adenocarcinoma of the pancreas.
abstract: Serum values of the tumor-associated antigen CA 19-9 are useful as an independent predictor of survival in patients with adenocarcinoma of the pancreas. However, the utility of biliary CA 19-9 values is unknown. This study was undertaken to determine whether biliary CA 19-9 levels are predictive of hepatic metastases. Between 1991 and 1996, thirty-eight patients treated for adenocarcinoma of the pancreas were evaluated using a biliary CA 19-9 assay. Bile was obtained from percutaneous stents placed during the perioperative period. Five of the 38 patients had low serum levels of CA 19-9 (<2 U/ml) and were excluded from the study. Twenty-seven (80%) of the 33 patients developed distant metastases: five pulmonary, five peritoneal, and 17 hepatic. Liver metastases were discovered initially in 10 and after resection of the primary tumor in seven (median interval 10 months). Biliary CA 19-9 values were significantly higher in patients with hepatic metastases (median 267, 400 U/ml; range 34,379 to 5,000,000 U/ml) compared to patients without metastatic disease (median 34,103 U/ml; range 6,620 to 239, 880 U/ml; P <0.006). Patients with hepatic, peritoneal, and pulmonary metastases had median survivals of 8,14, and 35 months, respectively (P <0.0041). All patients without metastatic disease are alive (median follow-up 13 months). Biliary CA 19-9 values are associated with a stepwise increase in the risk of developing metastatic disease. Patients with biliary CA 19-9 levels greater than 149,490 U/ml have an increased risk of developing recurrent disease in the liver and may warrant further hepatic evaluation or therapy.
authors.affiliation: Departments of Surgical Oncology and Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Montgomery
authors.forename: J P
authors.initials: JP
authors.lastname: Hoffma
authors.forename: E A
authors.initials: EA
authors.lastname: Ross
authors.forename: L B
authors.initials: LB
authors.lastname: Riley
authors.forename: J A
authors.initials: JA
authors.lastname: Ridge
authors.forename: B L
authors.initials: BL
authors.lastname: Eisenberg
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile / Q000737:chemistry* / Q000276:immunology; D018395:CA-19-9 Antigen / Q000032:analysis* / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary*; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000556:secondary; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D018395:CA-19-9 Antigen