title: Preoperative CEA and CA 19-9 are prognostic markers for survival after curative resection for ductal adenocarcinoma of the pancreas - a retrospective tumor marker prognostic study.
abstract: BACKGROUND
  The prognosis for patients with ductal adenocarcinoma of the pancreas (PDAC) remains poor even after curative resection. Carbohydrate antigen 19-9 (CA 19-9) and the carcinoembryonic antigen (CEA) are the most widely used serum-based tumor markers for the diagnosis and follow up of pancreatic cancer. In our analysis we aim to assess the prognostic value of a combination of both tumor markers in patients with pancreatic ductal adenocarcinoma (PDAC).
  
  
  METHODS
  Between 01/1995 and 08/2012 we performed a total of 264 pancreatic resections due to PDAC. Patients were stratified into 3 groups in regard to their preoperative tumor marker levels. Survival was compared between the groups using Kaplan Meier analysis and log rank test. Univariate subgroup analysis and multivariate analysis were performed.
  
  
  RESULTS
  For 259 cases complete follow up could be obtained. In patients with low preoperative CEA and CA 19-9 levels (group 1 n = 91) the mean survival was 33.3 month (CI 95% 25.1-41.5). If one of the analyzed tumor markers (CEA/CA19-9) was preoperatively elevated above the cut-off level (group 2 n = 106) mean survival was 28.5 month (CI 95% 22.1-35.1). 62 patients showed preoperative elevation of both, CEA and CA 19-9 (group 3); mean survival in this group was 23.9 month (CI 95% 13.9-33.9), p > 0.01. Multivariate analysis confirmed preoperative CEA/CA 19-9 level as independent prognostic factor (HR 1.299).
  
  
  CONCLUSIONS
  Preoperative CEA and CA 19-9 levels correlate with patient prognosis after curative pancreatic resection due to PDAC. This is especially true for the most frequently pT 3/4 stages of PDAC. Even if CEA and CA 19-9 might not be appropriate for screening, its serum levels should therefore be determined prior to operation and taken into account when resectability or operability is doubtful.
authors.affiliation: Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Germany. Electronic address: marius.distler@uniklinikum-dresden.de.
authors.forename: Marius
authors.initials: M
authors.lastname: Distler
authors.forename: Eva
authors.initials: E
authors.lastname: Pilarsky
authors.forename: Stephan
authors.initials: S
authors.lastname: Kersting
authors.forename: Robert
authors.initials: R
authors.lastname: Grützmann
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D018395:CA-19-9 Antigen / Q000097:blood*; D002272:Carcinoembryonic Antigen / Q000097:blood*; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen
keywords: CA 19-9; CEA; PDAC; Pancreatic cancer; Surgery; Tumor marker; carbohydrate-antigen 19-9; carcinoembryonic antigen; pancreatic ductal adenocarcinoma