Oncology/endocrineThe Use of Adjusted Preoperative CA 19-9 to Predict the Recurrence of Resectable Pancreatic Cancer
Introduction
Pancreatic adenocarcinoma may be one of the most devastating diagnoses for patients and their families. Prognosis remains dismal, and only a few patients can be surgical candidates due to locally advanced disease and distant metastasis at the time of diagnosis. Overall, 5-y survival is less than 5%, and only 10 to 20% of patients who undergo resection have long-term survival [1]. Moreover, even after curative surgery, 50 to 80% of patients experience local recurrence, and more than 50% develop distant metastasis, especially to the liver [2].
CA 19-9, initially described as a colorectal cancer marker, was later found to be associated with pancreatic cancer. Normally, low levels of CA 19-9 can be expressed in healthy individuals (<40 U/mL). Using CA 19-9 for the diagnosis and prognosis of patients with pancreatic cancer has been evaluated [3]; however, diagnostic utility is limited in occasional cases. Elevated CA 19-9 levels can occur not only in several cancers, including pancreatic, hepatocellular, colorectal, and ovarian neoplasms, but also in benign, pathologic conditions, such as pancreatitis and choledocholithiasis [4].
Several studies have evaluated the correlation between high levels of CA 19-9 and advanced pancreatic disease, as well as between recurrence and postoperative CA 19-9 levels [5, 6, 7]. We investigated whether preoperative CA 19-9 levels, adjusted to total bilirubin levels, can be used as a predictive factor for disease-free survival in patients undergoing surgery for pancreatic ductal adenocarcinoma.
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Patients and Methods
This was a retrospective study of patients who underwent surgical resection for pancreatic ductal adenocarcinoma from January 1990 to June 2005, at Yonsei Medical Center, Seoul, Korea. Data, including preoperative CA 19-9 levels and recurrence information, were obtained from a review of medical records. We controlled for bilirubin levels, as increased cholestasis falsely elevates CA 19-9 levels, likely a result of the decreased capacity of a cholestatic liver to degrade and excrete CA 19-9 [8, 9
Patient Demographics
During the study period, 102 patients underwent curative resection for pancreatic ductal adenocarcinoma. Among them, 61 patients had available medical records with data on both preoperative CA 19-9 levels and recurrence data. Of these patients, 39 were male and 22 were female, with a mean age of 60 y. General characteristics are listed in Table 1. The adjusted CA 19-9 levels were determined, as has been previously described. The adjusted CA 19-9 levels (mean ± SD, 129.4 ± 225.2 U/mL) were
Discussion
Pancreatic adenocarcinoma is the most devastating malignancy despite recent improvements in surgical and postoperative management. The overall survival rate is less than 5%, and even cumulative survival after resection is between 3.4 and 25% [11, 12, 13, 14]. In addition, recurrence and distant metastasis are common after resection. According to our data, the mean survival rate of patients with resectable pancreatic cancer was only 39.6 mo, and the 5-y survival rate was only 16.4%. Due to these
Conclusions
Adjusted preoperative CA 19-9 levels could predict the recurrence risk (disease-free survival) in patients with resectable pancreatic cancer. Our study suggests another clinical value of serum CA 19-9 in pancreatic cancer patients. In addition, when considering CA 19-9 biological properties and biliary excretion, the adjusted levels appear to be more reasonable than the actual levels of CA 19-9 in evaluating prognosis. We recommend that a well-designed prospective study to evaluate the
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