title: Postoperative serum CEA and CA125 levels are supplementary to perioperative CA19-9 levels in predicting operative outcomes of pancreatic ductal adenocarcinoma.
abstract: Carbohydrate antigen (CA19-9) is a well-established marker to monitor disease status after resection of pancreatic cancer. However, few serum markers have been reported to improve the prognostic ability of postoperative CA19-9, especially in patients with normal postoperative CA19-9.
  
  
  
  A total of 353 patients with pancreatic ductal adenocarcinoma treated by radical resection were reviewed retrospectively, and a prospective cohort including 142 patients with resectable pancreatic head carcinoma was analyzed as a validation cohort. Perioperative CA19-9 and postoperative serum markers (CEA, CA242, CA72-4, CA50, CA125, CA153, and AFP) were investigated.
  
  
  
  Patients with postoperative normalization of CA19-9 had improved survival times (recurrence-free survival: 11.9 months; overall survival: 22.5 months) compared with those with decreased but still elevated postoperative CA19-9 (recurrence-free survival: 6.8 months, P < .001; overall survival: 13.5 months, P < .001) or those with increased postoperative CA19-9 (recurrence-free survival: 3.5 months, P < .001; overall survival: 7.9 months, P < .001), which was similar to those with consistently normal CA19-9 during perioperative periods (recurrence-free survival: 10.6 months, P = .799; overall survival: 24.1 months, P = .756). Normal postoperative CA19-9 levels were an independent indicator for a positive outcome after operation, regardless of preoperative CA19-9 levels. Elevated postoperative CEA and CA125 were identified further as independent risk factors for patients with normal postoperative CA19-9, while elevated postoperative CA125 and nondecreased postoperative CA19-9 were independent prognostic markers for patients with elevated postoperative CA19-9.
  
  
  
  The postoperative monitoring of CEA and CA125 provided prognostic significance to the measurement of CA19-9 in pancreatic cancer after resection.
authors.affiliation: Department of Pancreatic Surgery, Pancreatic Cancer Institute, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai Cancer Center, Shanghai, P.R. China.
authors.forename: Hua-Xiang
authors.initials: HX
authors.lastname: Xu
authors.affiliation: Department of Pancreatic Surgery, Pancreatic Cancer Institute, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai Cancer Center, Shanghai, P.R. China.
authors.forename: Liang
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Pancreatic Surgery, Pancreatic Cancer Institute, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai Cancer Center, Shanghai, P.R. China.
authors.forename: Jin-Feng
authors.initials: JF
authors.lastname: Xiang
authors.affiliation: Department of Pancreatic Surgery, Pancreatic Cancer Institute, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai Cancer Center, Shanghai, P.R. China.
authors.forename: Wen-Quan
authors.initials: WQ
authors.lastname: Wang
authors.affiliation: Department of Pancreatic Surgery, Pancreatic Cancer Institute, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai Cancer Center, Shanghai, P.R. China.
authors.forename: Zi-Hao
authors.initials: ZH
authors.lastname: Qi
authors.affiliation: Department of Pancreatic Surgery, Pancreatic Cancer Institute, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai Cancer Center, Shanghai, P.R. China.
authors.forename: Chun-Tao
authors.initials: CT
authors.lastname: Wu
authors.affiliation: Department of Pancreatic Surgery, Pancreatic Cancer Institute, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai Cancer Center, Shanghai, P.R. China.
authors.forename: Chen
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Pancreatic Surgery, Pancreatic Cancer Institute, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai Cancer Center, Shanghai, P.R. China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Long
authors.affiliation: Department of Pancreatic Surgery, Pancreatic Cancer Institute, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai Cancer Center, Shanghai, P.R. China.
authors.forename: Jin
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Pancreatic Surgery, Pancreatic Cancer Institute, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai Cancer Center, Shanghai, P.R. China.
authors.forename: Quan-Xing
authors.initials: QX
authors.lastname: Ni
authors.affiliation: Department of Pancreatic Surgery, Pancreatic Cancer Institute, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai Cancer Center, Shanghai, P.R. China. Electronic address: yuxianjun@fudanpci.org.
authors.forename: Xian-Jun
authors.initials: XJ
authors.lastname: Yu
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods / Q000401:mortality*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D011956:Receptors, Cell Surface / Q000097:blood; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D018395:CA-19-9 Antigen; D011956:Receptors, Cell Surface; C065686:carcinoembryonic antigen binding protein, human