title: Preoperative CA19-9 levels and lymph node ratio are independent predictors of survival in patients with resected pancreatic ductal adenocarcinoma.
abstract: BACKGROUND
  The aim of this study was to identify whether preoperative CA19-9 levels might represent an independent prognostic marker for overall survival in patients undergoing resection for pancreatic ductal adenocarcinoma, and to describe the relationship between CA19-9 and tumour histology.
  
  
  METHODS
  109 patients who had a pancreatoduodenectomy for pancreatic ductal adenocarcinoma with recorded preoperative CA19-9 levels were identified from a prospectively maintained database (1997-2006). Multivariate analysis was conducted using a Cox proportional hazards model with continuous covariates where possible.
  
  
  RESULTS
  The median survival of 64 patients with a preoperative CA19-9 level >150 kU/l was 10.4 months while in 45 patients with a CA19-9 level <or=150 kU/l this was 22.1 months (corrected p = 0.012). Also significant on univariate analyses were overall lymph node status (p = 0.011), lymph node ratio (p = 0.003) and tumour diameter (p = 0.004). Preoperative CA19-9 levels >150 kU/l were associated with a larger, more poorly differentiated tumour along with an increased likelihood of a positive resection margin status (all p < 0.05). Preoperative CA19-9 levels (p = 0.030) and lymph node ratio (p = 0.042) emerged as independent predictors of survival on multivariate analysis.
  
  
  CONCLUSIONS
  Preoperative CA19-9 levels and lymph node ratio were significant predictors of survival in resected pancreatic ductal adenocarcinoma.
authors.affiliation: Division of Surgery and Oncology, School of Cancer Studies, University of Liverpool, Liverpool, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Smith
authors.forename: L
authors.initials: L
authors.lastname: Bosonnet
authors.forename: P
authors.initials: P
authors.lastname: Ghaneh
authors.forename: M
authors.initials: M
authors.lastname: Raraty
authors.forename: R
authors.initials: R
authors.lastname: Sutton
authors.forename: F
authors.initials: F
authors.lastname: Campbell
authors.forename: J P
authors.initials: JP
authors.lastname: Neoptolemos
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood*; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods; D011300:Preoperative Care; D011379:Prognosis; D016019:Survival Analysis
chemical_list: D018395:CA-19-9 Antigen; D001663:Bilirubin