Further evidence of the prognostic role of pretreatment levels of CA 19-9 in advanced pancreatic cancer

Abstract

SummaryObjective. We and others have previously suggested that pretreatment levels of CA 19-9 correlate with overall survival (OS) among patients with advanced pancreatic cancer treated with gemcitabine. We sought to confirm the prognostic role of the pretreatment level of CA 19-9 in patients with advanced pancreatic cancer treated with chemotherapy. MethOds. We retrospectively identified 50 patients with locally advanced or metastatic pancreatic cancer treated in the first-line with single-agent gemcitabine or combinations. Patients could also have received second-line treatment. Kaplan-Meier estimates of OS were compared with the log-rank test, and multivariate analysis was done using the Cox model. Results. Twenty-seven patients were female with a mean age of 64.3 years, and 82% were metastatic upon diagnosis. The median OS for the entire sample was 11 months, and the median CA 19-9 level was 542 U/mL. Significant predictors of OS in univariate analyses were the first-line use of combined chemotherapy (p=0.006) and use of erlotinib in any line (p=0.002), with borderline significance for pretreatment levels of CA 19-9 (p=0.052). In multivariate analysis, only use of erlotinib (p=0.003) and pretreatment CA 19-9 level (p=0.026) were significantly associated with OS. cOnclusiOn. Our study lends further support to use of the pre-chemotherapy level of CA 19-9 as a prognostic indicator in clinical practice and as a stratification factor in clinical trials. The association between erlotinib use and OS may have been biased by patient selection, notwithstanding the positive results from a previous randomized trial.

An overview of recently published medical papers in Brazilian scientific journals

“…Matos et al49 present a series of 93 consecutive patients who had elective surgery for known gallbladder polyps, treated from January 2003 to December 2007 and claim that cholecystectomy is the appropriate surgical treatment for gallbladder polyps, when removal is warranted. Saad et al50 have previously suggested that pretreatment levels of CA 19-9 correlate with overall survival among patients with advanced pancreatic cancer treated with gemcitabine; they sought to confirm the prognostic role of the pretreatment level of CA 19-9 and found further evidence in favor of the concept. Fanger et al51 describe high prevalence rates of depression and suicidal behavior among cancer patients and suggest that simple screening instruments and specific questions during interviews are needed to detect these clinical conditions.…”

“…This led Ardengh et al61 to evaluate results from endoscopic ultrasonography for diagnosis of gallbladder microlithiasis in patients with unexplained (idiopathic) acute pancreatitis and found it to be a very reliable procedure to diagnose gallbladder microlithiasis and should be used for the management of patients with unexplained acute pancreatitis. Saad et al50 have previously suggested that pretreatment levels of CA 19-9 correlate with overall survival among patients with advanced pancreatic cancer treated with gemcitabine; they sought to confirm the prognostic role of the pretreatment level of CA 19-9 and found further evidence in favor of the concept. Coelho et al62 compared data of patients submitted to appendectomy for acute appendicitis at a public and at a private hospital.…”

Combination of tumor markers predicts progression and pathological response in patients with locally advanced gastric cancer after neoadjuvant chemotherapy treatment

“…As a mucin antigen with high molecular weight, CA19-9 is hypothesized to act as an anti-adhesive molecule contributing to tumor migrations and to locally inhibit T cell-mediated antitumor response [ 23 , 24 ]. Moreover, the prominent predictive ability of CA19-9 for pancreatic cancer indicated the possibility to measure tumor biology from a quantitative view [ 11 , 25 ]. CA72-4 was initially designated as a tumor-associated glycoprotein-72 which has been found in various epithelial malignancies tumors as well as benign gastritis [ 26 , 27 ].…”

Assessing the clinical significance of tumor markers in common neoplasms

“…Numerous studies have shown that increases in CA 19-9 are associated with poor outcome and survival, therefore serum CA 19-9 concentration showed to be an independent prognostic marker (97). Some studies have revealed that pretreatment level of CA 19-9 can be used as a prognostic indicator in patients with advanced pancreatic cancer (98,99). Other studies showed that postoperative CA19-9 is a better prognostic marker than preoperative CA 19-9 (100).…”