title: Preoperative CA 19-9 kinetics as a prognostic variable in radiographically resectable pancreatic adenocarcinoma.
abstract: OBJECTIVE
  Serial levels of CA 19-9 are correlated with treatment response and survival; however, little is known about CA 19-9 kinetics in the absence of therapy. We hypothesize that preoperative CA 19-9 kinetics predict rate of resectability as well as survival.
  
  
  METHODS
  Retrospective review of 72 patients with radiographically resectable pancreatic adenocarcinoma with two pre-operative CA 19-9 levels prior to planned pancreaticoduodenectomy. Primary outcome measures were resectability and overall survival.
  
  
  RESULTS
  Forty-seven out of 72 patients (65%) had resectable disease. Unresectable patients had higher absolute change in CA 19-9 than patients with resectable disease (97 U/ml vs. -34 U/ml) as well as higher rate of change (4 U/ml/day vs. -1 U/ml/day). Receiver operating characteristic curves identified predictive thresholds for absolute (≥50 U/ml) and rate of CA 19-9 change (≥1 U/ml/day) that accurately identified unresectable patients. Survival analysis revealed that a change in CA 19-9 <50 U/ml and a rate of change <1 U/ml/day predicted improved survival (P = 0.04, P = 0.02); however, for patients with resectable disease, CA 19-9 changes did not predict survival.
  
  
  CONCLUSIONS
  Preoperative kinetics of CA 19-9 predict resectable disease for pancreatic cancer. These variables also predict overall survival; however, these do not predict survival for those with resectable disease.
authors.affiliation: Division of Surgical Oncology, UC Davis Cancer Center, Sacramento, California, 95817.
authors.forename: Erin G
authors.initials: EG
authors.lastname: Brown
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Canter
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bold
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen
keywords: CA19-9; pancreas cancer; tumor marker