title: The prognostic and predictive value of serum CA19.9 in pancreatic cancer.
abstract: BACKGROUND
  Current staging methods for pancreatic cancer (PC) are inadequate, and biomarkers to aid clinical decision making are lacking. Despite the availability of the serum marker carbohydrate antigen 19.9 (CA19.9) for over two decades, its precise role in the management of PC is yet to be defined, and as a consequence, it is not widely used.
  
  
  METHODS
  We assessed the relationship between perioperative serum CA19.9 levels, survival and adjuvant chemotherapeutic responsiveness in a cohort of 260 patients who underwent operative resection for PC.
  
  
  RESULTS
  By specifically assessing the subgroup of patients with detectable CA19.9, we identified potential utility at key clinical decision points. Low postoperative CA19.9 at 3 months (median survival 25.6 vs 14.8 months, P=0.0052) and before adjuvant chemotherapy were independent prognostic factors. Patients with postoperative CA 19.9 levels>90 U/ml did not benefit from adjuvant chemotherapy (P=0.7194) compared with those with a CA19.9 of ≤90 U/ml (median 26.0 vs 16.7 months, P=0.0108). Normalization of CA19.9 within 6 months of resection was also an independent favorable prognostic factor (median 29.9 vs 14.8 months, P=0.0004) and normal perioperative CA19.9 levels identified a good prognostic group, which was associated with a 5-year survival of 42%.
  
  
  CONCLUSIONS
  Perioperative serum CA19.9 measurements are informative in patients with detectable CA19.9 (defined by serum levels of >5 U/ml) and have potential clinical utility in predicting outcome and response to adjuvant chemotherapy. Future clinical trials should prioritize incorporation of CA19.9 measurement at key decision points to prospectively validate these findings and facilitate implementation.
authors.affiliation: Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, Australia.
authors.forename: J L
authors.initials: JL
authors.lastname: Humphris
authors.forename: D K
authors.initials: DK
authors.lastname: Chang
authors.forename: A L
authors.initials: AL
authors.lastname: Johns
authors.forename: C J
authors.initials: CJ
authors.lastname: Scarlett
authors.forename: M
authors.initials: M
authors.lastname: Pajic
authors.forename: M D
authors.initials: MD
authors.lastname: Jones
authors.forename: E K
authors.initials: EK
authors.lastname: Colvin
authors.forename: A
authors.initials: A
authors.lastname: Nagrial
authors.forename: V T
authors.initials: VT
authors.lastname: Chin
authors.forename: L A
authors.initials: LA
authors.lastname: Chantrill
authors.forename: J S
authors.initials: JS
authors.lastname: Samra
authors.forename: A J
authors.initials: AJ
authors.lastname: Gill
authors.forename: J G
authors.initials: JG
authors.lastname: Kench
authors.forename: N D
authors.initials: ND
authors.lastname: Merrett
authors.forename: A
authors.initials: A
authors.lastname: Das
authors.forename: E A
authors.initials: EA
authors.lastname: Musgrove
authors.forename: R L
authors.initials: RL
authors.lastname: Sutherland
authors.forename: A V
authors.initials: AV
authors.lastname: Biankin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D059035:Perioperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen