Predictive Value of Preoperative Serum CA19-9 on Margin Status

Abstract

Serum carbohydrate antigen (CA19-9) is known to correlate with stage, resectability, and prognosis of pancreatic cancer. The goal of pancreaticoduodenectomy is to achieve an R0 resection because worse outcomes are reported in the presence of positive margins. The purpose of this study was to evaluate the predictive utility of CA19-9 for pancreaticoduodenectomy margin status. A retrospective review of patients with pancreatic adenocarcinoma undergoing pancreaticoduodenectomy between October 2007 and November 2018 at our institution was performed. Patient demographics, preoperative CA19-9, and tumor characteristics were analyzed. Univariate and mul-tivariate logistic regression was performed to determine factors associated with positive margins. A total of 184 patients were included. The mean age was 65 years; most patients were male and white. Majority had a positive preoperative CA19-9 (69%). There were nearly twice as many patients with negative as positive margins. Groups had similar demographics and preoperative CA19-9. A greater proportion of patients with negative margins had smaller tumors and early disease. On univariate and multivariate analysis, larger and higher stage tumors had greater odds of positive margins ( P < 0.05). There was no significant association between margin status and preoperative CA19-9. Preoperative CA19-9 is not predictive of margin status. These results suggest that although preoperative CA19-9 values are associated with both resectability and prognosis, positive margins may not be a contributing mechanism.

CA19.9 Serum Level Predicts Lymph-Nodes Status in Resectable Pancreatic Ductal Adenocarcinoma: A Retrospective Single-Center Analysis

“…These findings disagree with what was reported by Mosquera in a retrospective review on 181 pancreatic cancer patients who had undergone radical pancreaticoduodenectomy, did not find any significant association between the R+ and preoperative levels of Ca 19.9 (38).…”

Role of CA 19.9 in the Management of Resectable Pancreatic Cancer: State of the Art and Future Perspectives

“…In a series including 184 patients, they studied the potential association between CA 19.9 and R+; the study population was divided according to various preoperative CA 19.9 levels. Unlike others, they did not find any association with R+, even when CA 19.9 > 1000 U/mL was considered [ 31 ].…”

“…Regarding the ability of CA 19.9 to predict the positivity of the lymph node status before surgery, the risk of a resection with positive margins, the need to proceed with a vascular resection, and the analysis of the literature we conducted ( which certainly is not to be considered exhaustive) would seem to confirm the potential of CA 19.9 [ 9 , 17 , 19 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”