Evaluation of the utility of a radioimmunoassay for serum CA 19-9 levels in patients before and after treatment of carcinoma of the pancreas.

Abstract

By radioimmunoassay we determined circulating levels of a tumor-associated antigen, CA 19-9, in 47 patients with pancreatic adenocarcinoma, to learn if serial testing was useful in predicting prognosis or in detecting disease progression. Before treatment, 42 (89%) had an abnormal serum level, and 45 (96%) had an abnormal level at some time during the disease course. A pretreatment value of less than 1,000 U/mL (normal, less than or equal to 37 U/mL) was found in 38 patients; 20 (53%) had resectable disease. One of nine patients (11%) with a pretreatment value greater than 1,000 U/mL had resectable disease (P2 = .05). Among 14 patients who underwent pancreatectomy and were studied serially, the CA 19-9 level normalized in eight; seven (88%) survived greater than or equal to 18 months. Six patients whose levels did not normalize after pancreatectomy all died in less than 12 months (P2 less than .005). Greatly elevated levels occurred in 11 patients after pancreatectomy 1 to 7 months before clinically apparent recurrence. The other three patients without significant elevations remain clinically free of disease. The data suggest that serial determination of serum CA 19-9 levels are useful as a prognostic indicator and in detecting disease recurrence following pancreatectomy. Concurrent determinations of carcinoembryonic antigen (CEA) levels showed abnormal preoperative values in 28 of 46 patients tested (61%). Concurrent serial postoperative determinations of CEA were available in ten patients. Whereas CA 19-9 values clearly indicated eight recurrences, CEA was helpful in only four. In this small group of patients, CA 19-9 was a better predictor of recurrence.

CA19-9 Does Not Predict cholangiocarcinoma in Patients With Primary Sclerosing Cholangitis Undergoing Liver Transplantion

“…Thus, 2 of 12 patients with elevated serum CA19-9 levels had CCA, versus 2 of 14 patients whose serum CA19-9 levels were within the reference range (P = NS), Sensitivity for serum (2419-9 levels greater than twice the reference range is SO%, specificity is 54.5%. Positive predictive value for this cut-off value is 16.6%. There was no significant gender difference between the two groups (Table 1).…”

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

“…CA19-9 is a sialylated Lewis blood group antigen targeted by the monoclonal antibody 1116 NS 19-9 (Koprowski et al, 1979). Previous studies have demonstrated a prognostic role for pretreatment CA19-9 in patients receiving radiotherapy or undergoing pancreatic resection (Glenn et al, 1988). Although a small number of papers have described a fall in CA19-9 to be an independent prognostic variable for survival (Gogas et al, 1998;Saad et al, 2002;Stemmler et al, 2003;Ziske et al, 2003), there have been surprisingly few studies investigating the use of baseline CA19-9 in predicting survival for patients with inoperable pancreatic cancer who undergo systemic chemotherapy.…”

Prognostic value of CA 19-9 levels in patients with inoperable adenocarcinoma of the pancreas treated with gemcitabine

“…It is the most sensitive and specific serum marker for pancreatic cancer (Pleskow et al, 1989;Rollhauser and Steinberg, 1998). The prognostic value of CA 19-9 for patients with pancreatic cancer treated by resection or radiotherapy is well established (Glenn et al, 1988;Katz et al, 1998;Rollhauser and Steinberg, 1998), but only few data regarding the prognostic value of CA 19-9 during chemotherapy with gemcitabine have been published so far. No prospective studies comparing clinical benefit response and CA 19-9 response were performed.…”