CA19-9 as a prognostic factor in inoperable pancreatic cancer: the implication for clinical trials

Abstract

In a multivariate analysis of 154 patients receiving chemotherapy, baseline CA19-9 was an independent prognostic factor for overall survival (OS) (HR 1.8; 95% CI: 1.3 -2.5, P ¼ 0.0004). The 1-year OS was 19 and 46%, respectively, for patients with a baseline CA19-9 above or below the median value. A fall of 20% in CA19-9 level from baseline was an independent prognostic factor for OS (HR 1.9; 95% CI: 1.1 -3.4, P ¼ 0.019).

Serum CA 19-9 as a Biomarker for Pancreatic Cancer—A Comprehensive Review

“…Whether serum CA 19-9 levels can be used as a surrogate marker of response to chemotherapy has been studied in a variety of clinical settings [41,44,[53][54][55][56][57][58][59][60][61][62][63][64]. Willett et al measured CA 19-9 serum levels in 42 resectable pancreatic cancer patients receiving neoadjuvant treatment with 5-flourouracil and external beam radiation prior to planned pancreaticoduodenectomy.…”

“…Nearly all studies have demonstrated that a treatment related decline in CA 19-9 serum levels is associated with prolonged survival and is an independent predictor of overall survival [41,44,[53][54][55][56][57][58][59][60][61][62][63][64] (Table 5). Reni et al compared basal CA 19-9 serum levels in 247 advanced pancreatic cancer patients enrolled in five consecutive chemotherapy trials (G, gemcitabine; PEFG, cisplatin, epirubicin, 5-fluorouracil, and gemcitabine; PDXG, cisplatin, docetaxel, capecitabine, and gemcitabine) [60].…”

“…In summary, these studies suggest that a median CA 19-9 serum level <100 U/ml correlates with resectability (41-80%) whereas levels >100 U/ml suggest advanced or metastatic pancreatic cancer (60-85%) (Table 3). The utility of serum CA 19-9 levels to provide meaningful prognostic information and permit patient stratification (survival groups) based on CA 19-9 serum level has been extensively evaluated [22,24,26,30,31,[36][37][38][39][40][41][42][43][44][45][46][47][48][49] (Table 4). Waraya et al performed a multivariate analysis of factors predicting survival in 117 pancreatic cancer patients undergoing surgical resection and reported that a low preoperative CA 19-9 serum levels (28-30 U/ml) (p<0.0016, relative risk (RR), 2.16) and positive peripancreatic margin (p<0.04, RR, 1.62) independently predicted survival [46].…”

“…U/ml unit/milliliter, SD standard deviation, NA not available, R0 resection-microscopic margin tumor free, R1 resection-microscopic margins positive for tumor, R2 resection-macroscopic tumor left behind Author, Year N= CA 19-9 cut-off levels (U/ml) Median survival (months) 4 months in patients with a preoperative CA19-9 level >150 U/ml (N=64), compared to a median survival of 22.1 months in patients with a CA19-9 serum level ≤150 U/ml (N=45, p<0.012) [45]. Table 3 lists additional studies which have used various cut-off levels for pre-operative CA 19-9 serum levels in an effort to predict survival among pancreatic cancer patients [22,24,26,30,31,[36][37][38][39][40][41][42][43][44][45][46][47][48][49]. These studies support the conclusion that a normal (<37 U/ml) or low preoperative CA 19-9 serum level (<100 U/ml) correlates with early pancreatic cancer stage and independently predicts improved overall survival, whereas an elevated CA 19-9 serum levels (>100 U/ml) is associated with a poor prognosis.…”

Gastrazole (JB95008), a novel CCK2/gastrin receptor antagonist, in the treatment of advanced pancreatic cancer: results from two randomised controlled trials

“…Ln, log; Diff, difference; Wk, week. 0.53; P ¼ 0.019) have been shown to have a superior survival (Maisey et al, 2005). CA19-9 may serve as an early indication of treatment efficacy with cytotoxic drugs, but interpretation of CA19-9 kinetics is more complex with other molecular targeted drugs.…”