Prognosis of resected ampullary adenocarcinoma by preoperative serum CA19-9 levels and platelet-lymphocyte ratio.
BACKGROUND
The objective of this study was to evaluate whether preoperative CA19-9 levels and the platelet-lymphocyte ratio (PLR) might reflect prognostic indices for resected ampullary adenocarcinoma.


METHODS
Data were collected prospectively over a 10-year period for consecutive patients undergoing pancreatoduodenectomy for malignancy.


RESULTS
Both preoperative PLR and CA19-9 results were available in 52 cases of resected ampullary adenocarcinoma. Preoperative CA19-9 levels of </=150 kU/l (or </=300 kU/l in the presence of bilirubin levels >35 micromol/l) and a PLR of </=160 were found to represent the optimal cut-off values to risk stratify patients. If both levels were elevated (n = 8), patients had a median overall survival of 10.1 months. If either CA19-9 or PLR were elevated individually (n = 23), patients had a median survival of 25.2 months. For cases where both levels were less than the cut-off values (n = 21), the median overall survival time was not reached but was greater than 60 months (log rank, p < 0.001). This preoperative risk stratification was found to remain a significant independent predictor of survival on multivariate analysis (Cox, p = 0.001) alongside resection margin status (p = 0.002) and tumor size (p = 0.051).


CONCLUSIONS
Preoperative CA19-9 and PLR both merit further evaluation as prognostic indices in resected ampullary adenocarcinoma.
Smith
Richard A
RA
Division of Surgery and Oncology, School of Cancer Studies, Royal Liverpool University Hospital, 5th Floor UCD Building, Daulby St., Liverpool, L69 3GA, UK.
Ghaneh
Paula
P
Sutton
Robert
R
Raraty
Michael
M
Campbell
Fiona
F
Neoptolemos
John P
JP
D000230:Adenocarcinoma / Q000097:blood* / Q000473:pathology / Q000601:surgery; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D001792:Blood Platelets / Q000473:pathology*; D018395:CA-19-9 Antigen / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods*; D010976:Platelet Count; D011379:Prognosis; D011446:Prospective Studies
D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen