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Predictive and prognostic value of CA 19-9 in resected pancreatic adenocarcinoma
Joshua G Barton1, John P Bois, Michael G Sarr
1Department of Surgery, Division of GI and General Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
Background:
Preoperative serum values of CA 19-9 have been reported to be associated with survival in patients undergoing resection of pancreatic adenocarcinoma.
Hypothesis:
Preoperative CA 19-9 levels are associated with margin and/or lymph node status in patients undergoing pancreatoduodenectomy for pancreatic carcinoma.
Methods:
We conducted a review of 143 patients undergoing pancreatoduodenectomy for pancreatic adenocarcinoma from July 2001 through April 2006 at our institution. Preoperative serum values of CA 19-9 and total bilirubin, pathologic findings, and survival were analyzed. A cutoff value for CA 19-9 (120 U/ml) was determined using a Cox proportional hazards model for survival.
Results:
Overall survival at 1, 3, and 5 years for patients with CA 19-9 < or = 120 U/ml was 76%, 41%, and 31%, respectively, versus 64%, 17%, and 10% for patients with CA 19-9 > 120 U/ml (p = 0.002). CA 19-9 > 120 U/ml was not associated, however, with a greater chance of an R1 or R2 resection (p = 0.86), tumor involving the SMA margin (p = 0.88), tumor at the portal vein groove (p = 0.14), or lymph node metastases (p = 0.89).
Conclusions:
Our findings do not support a cutoff value for CA 19-9 that is associated with margin or lymph node involvement. Preoperative CA 19-9 < or = 120 U/ml is, however, associated with increased overall and recurrence-free survival.
