Pretreatment CA 19-9 level as a prognostic factor in patients with advanced pancreatic cancer treated with gemcitabine.
BACKGROUND
Serum levels of CA 19-9 correlate with survival among patients with pancreatic cancer treated with surgery or radiation therapy. In addition, CA 19-9 responses have been shown to predict for a better prognosis among patients with advanced disease treated with chemotherapy. The present study evaluates the predictive role of CA 19-9 pretreatment levels and response among patients treated with gemcitabine.


METHODS
We retrospectively identified 28 patients with advanced pancreatic cancer and baseline elevations of CA 19-9 (> 37 U/mL) who were treated with single agent gemcitabine. CA 19-9 response was defined as a > or = 50% decline at any time after treatment. Survival was estimated with the Kaplan-Meier method, and curves were compared with the log-rank test.


RESULTS
Eleven patients (39%) had a CA 19-9 response. The median survival of responding patients was longer than that of non-responding patients (13.8 vs 8 mo, p = .0272). When pretreatment CA 19-9 levels were analyzed, patients who had CA 19-9 below the median for the entire sample (1212 U/mL) lived significantly longer than patients with a CA 19-9 above the median (14.9 vs 7.4 mo, p = .0013). On multivariable analysis, pretreatment CA 19-9 level was an independent, and stronger predictor of survival (p = .0005) than CA 19-9 response (p = .0497). Other variables were not associated with survival.


CONCLUSIONS
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.
Saad
Everardo D
ED
Centro Paulista de Oncologia, São Paulo, Brazil. evesaad@yahoo.com
Machado
Marcel C
MC
Wajsbrot
Dalia
D
Abramoff
Roberto
R
Hoff
Paulo M
PM
Tabacof
Jacques
J
Katz
Artur
A
Simon
Sergio D
SD
Gansl
René C
RC
D000230:Adenocarcinoma / Q000097:blood* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm / Q000097:blood*; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D018395:CA-19-9 Antigen / Q000097:blood*; D018196:Carcinoma, Adenosquamous / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D011379:Prognosis; D012189:Retrospective Studies; D000093542:Gemcitabine
D000951:Antigens, Neoplasm; D000964:Antimetabolites, Antineoplastic; D018395:CA-19-9 Antigen; D003841:Deoxycytidine; D000093542:Gemcitabine