Prognostic value of CA 19-9 level in resectable pancreatic adenocarcinoma.

Abstract

Abstract:The prognosis in patients with pancreatic cancer is poor and some authors describe it as a lethal disease. At the time of diagnosis only 14% of patients could be surgically treated and up to 30% of them die within 12 months. Therefore, further clinical investigations on preoperative patient qualification are needed. A total of 81 patients were included into the study. The CA 19-9 concentration was measured before surgery by an automated, commercially available enzyme immunoassay in Axsym analyzer (Abott Diagnostics Laboratory). A value of 37 U/ml was used as the upper limit of normal levels. Tumors were staged according to the Union Against Cancer (UICC) of 2004 and graded during the histological evaluation according to the G0-G4 scale. All patients were monitored every three month via outpatient clinic visits. In the case of missing visit we contacted the families to establish the cause. We assessed perioperative, 12 month, 2 year and 5 year survival. Twelve moth, 2 year and 5 year survival were assessed in the whole studied population and in the group of patients with the exception of these who died during the perioperative period. The total five year survival was 6%. The median time of survival was 467 days (range: 163 -586 days). The perioperative period was survived by 91.4% patients, 12 months were survived by 71.6% patients, 2 years were survived by 35.8% patients, 5 years were survived by 6.2% patients. The serum Ca 19-9 level was above the normal limit in 80.5% patients. ROC curve analysis revealed that CA 19-9 level of more than 106 U/ml was linked to 2 year survival with 79.3% sensitivity and 74.5% specificity. Preoperative level of CA 19-9 below 106U/ml represents a predictive factor of 2-and 5-year survival, independent of other factors, such as lower size of the tumor, absence of metastases to lymph nodes, female gender of patients.After exclusion of the patients who died in the perioperative period, no relationship could have been disclosed between preoperative CA 19-9 levels and one year survival. The observation points to the chance that patients with higher levels of CA 19-9 harbour micrometastases, the development of which is sufficiently slow to allow for a one-year survival of the patients but which increase the risk of death after two and five years

Application of biochemical markers CA 19-9, CEA and C-reactive protein in diagnosis of malicious and benign pancreatic tumors

“…Sensitivity is the ability of the test to detect disease. CA 19-9 has been shown to have a specificity of approximately 85% and a sensitivity of 90% [15, 17]. In our study, the sensitivity is 88%.…”

“…Currently, the best known and examined pancreatic cancer marker is CA 19-9. The characteristics of an ideal marker are high sensitivity, high specificity, predictive value and specificity of the organ [15]. …”

Long-term outcome and prognostic factors of pancreatic ductal adenocarcinoma after laparoscopic pancreaticoduodenectomy

“…Other studies have also indicated that elevated serum CA19-9 levels are associated with aggressive tumor behavior, such as larger tumor size, lymph node metastasis, peritoneal in ltration, and liver metastasis. 19 For CA242, some studies have found through immunohistochemistry as well as biochemistry that CA242 is most likely a product of tumor cells, so high levels of CA242 are associated with increased tumor burden. 14 It has also been shown that CA242 levels are elevated in patients with advanced pancreatic cancer, which strongly predicts that elevated preoperative CA242 levels are strongly associated with metastatic and aggressive behavior of the tumor and can present a very poor prognosis for the patients.…”

Pancreatic mucinous cystadenoma with serum CA 19–9 over 1,000,000 U/mL: a case report and review of the literature

“…It is the only blood test approved by the Food and Drug Administration (FDA) for pancreatic adenocarcinoma. CA 19–9 has demonstrated specificity of approximately 85% and sensitivity of 90% [ 9 , 10 ], and its prognostic value for survival is more associated with high postoperative dosage [ 11 ].…”