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Very high serum CA 19-9 levels: a contraindication to pancreaticoduodenectomy?
O Turrini1, C M Schmidt, J Moreno
1Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Insights
High preoperative CA 19-9 levels in pancreatic adenocarcinoma patients do not necessarily indicate poor prognosis. Normalizing CA 19-9 after surgery leads to survival similar to controls.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Biomarkers
Background:
- Pancreatic adenocarcinoma (PA) often presents with elevated serum CA 19-9.
- The prognostic significance of high CA 19-9 levels in resectable PA remains a clinical challenge.
Purpose of the Study:
- To evaluate the survival outcomes of patients with resectable PA and elevated preoperative serum CA 19-9 levels.
- To determine if the degree of CA 19-9 elevation impacts prognosis.
- To assess the impact of postoperative CA 19-9 normalization on survival.
Main Methods:
- Retrospective analysis of 344 patients undergoing pancreatoduodenectomy for PA (2000-2007).
- Comparison of survival between a control group (normal CA 19-9) and an elevated group (CA 19-9 >400 IU/ml).
- Subgroup analysis of elevated group based on CA 19-9 levels (400-899 IU/ml vs. >=900 IU/ml) and postoperative normalization.
Main Results:
- Patients with elevated CA 19-9 had significantly shorter median survival (15 vs. 22 months) and 3-year survival (14% vs. 32%) compared to controls.
- No significant difference in survival was observed between high and very high CA 19-9 subgroups.
- Patients who normalized CA 19-9 levels post-surgery demonstrated survival comparable to the control group.
Conclusions:
- Postoperative normalization of CA 19-9 levels in PA patients is associated with favorable survival outcomes.
- Preoperative CA 19-9 levels alone should not be a contraindication for surgery in carefully staged PA patients.
Aim:
To assess the outcome of patients with resectable pancreatic adenocarcinoma (PA) associated with high serum CA 19-9 levels.
Methods:
From 2000 to 2007, 344 patients underwent pancreatoduodenectomy for PA. Fifty-three patients (elevated group) had preoperatively elevated serum CA 19-9 levels (>400 IU/ml) after resolution of obstructive jaundice. Of these, 27 patients had high levels (400-899 IU/ml (HL)) and 26 patients had very high levels >or=900 IU/ml (VHL). Fifty patients with normal preoperative serum CA 19-9 levels (<37 IU/ml) comprised the control group.
Results:
Median survival of the control group (n = 50) versus elevated group (n = 53) was 22 versus 15 months (p = 0.02) and overall 3-year survival was 32% versus 14% (p = 0.03). There was no statistical difference in the median and 3-year overall survival between patients with HL and VHL. Patients in the elevated group who normalized their CA 19-9 levels after surgery (n = 11) had a survival equivalent to patients in the control group.
Conclusions:
Patients who normalized their CA19-9 levels postoperatively had equivalent survival to patients with normal preoperative CA 19-9 levels. Preoperative serum CA 19-9 level by itself should not preclude surgery in patients who have undergone careful preoperative staging.
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