Predictive and prognostic value of CA 19-9 in resected pancreatic adenocarcinoma.
BACKGROUND
Preoperative serum values of CA 19-9 have been reported to be associated with survival in patients undergoing resection of pancreatic adenocarcinoma.


OBJECTIVE
Preoperative CA 19-9 levels are associated with margin and/or lymph node status in patients undergoing pancreatoduodenectomy for pancreatic carcinoma.


METHODS
We conducted a review of 143 patients undergoing pancreatoduodenectomy for pancreatic adenocarcinoma from July 2001 through April 2006 at our institution. Preoperative serum values of CA 19-9 and total bilirubin, pathologic findings, and survival were analyzed. A cutoff value for CA 19-9 (120 U/ml) was determined using a Cox proportional hazards model for survival.


RESULTS
Overall survival at 1, 3, and 5 years for patients with CA 19-9 < or = 120 U/ml was 76%, 41%, and 31%, respectively, versus 64%, 17%, and 10% for patients with CA 19-9 > 120 U/ml (p = 0.002). CA 19-9 > 120 U/ml was not associated, however, with a greater chance of an R1 or R2 resection (p = 0.86), tumor involving the SMA margin (p = 0.88), tumor at the portal vein groove (p = 0.14), or lymph node metastases (p = 0.89).


CONCLUSIONS
Our findings do not support a cutoff value for CA 19-9 that is associated with margin or lymph node involvement. Preoperative CA 19-9 < or = 120 U/ml is, however, associated with increased overall and recurrence-free survival.
Barton
Joshua G
JG
Department of Surgery, Division of GI and General Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
Bois
John P
JP
Sarr
Michael G
MG
Wood
Christina M
CM
Qin
Rui
R
Thomsen
Kristine M
KM
Kendrick
Michael L
ML
Farnell
Michael B
MB
D000368:Aged; D001663:Bilirubin / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood*; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D018395:CA-19-9 Antigen; D001663:Bilirubin