Elevated preoperative levels of CA19-9 and CA125 predicts overall survival time inthe pancreatic adenocarcinoma. Single institution series.

Abstract

<b>Introduction: </b>Pancreatic cancer is a devastating disease, being the seventh cause of cancer-related deaths worldwide. Its aggressiveness is due to its specific biology and the late diagnosis of cancer. Therefore, the prognosis for patients suffering from this cancer is dismal, with 5-year overall survival rate of around 6-10%. Up to date, only a complete surgical resection of the cancerous entity warrants a significant improvement in patients' survival. Nevertheless, the pancreatic cancer's biology is still not fully elucidated, so that the accuracy of prognosis for certain patients is highly uncertain. Consequently, the importance of both clinical and basic research aiming to reveal the crucial molecular factors affecting long-term prognosis should be highlighted. There is a growing number of evidence that biomarkers of PC not only reflect the presence of tumor itself but also present a "hint" regarding its physiology. Thus the aim of this study was to assess the levels of commonly measured biomarkers and their influence on patients' overall survival. <br><b>Materials and methods: </b>The retrospective analysis of data on 129 patients admitted to our Department due to the diagnosis of pancreatic cancer was carried out. On the day of admission all the patients had their levels of CA<sub>19-9</sub>, CA<sub>125</sub>, CEA and CA<sub>15-3</sub> measured. The overall survival (OS) was defined as time elapsing from the day of admission to the day of death. The Kaplan- Meier curves were built for all potential factors, Cox regression model was applied to carry out a multivariate analysis. <br><b>Results: </b>We retrospectively analyzed 129 patients with a mean age of 62 years. As many as 95 of them had an unresectable lesion and 34 underwent curative operation. In total, the analyzed patient group was characterized by a median survival of 7 months and 12 days. Cumulative 1-year, 2-year and 4-year survival rates were 35%, 16% and 15%, respectively. In univariate analysis, factors such as age >= 60, inoperable lesion, CA<sub>19-9</sub> >= 200, CA<sub>125</sub> >= 20 and Neutrophile to Lymphocyte Ratio (NLR) >= 5 were associated with a lower median OS. In multivariate analysis, three factors, CA<sub>19-9</sub> >= 200, CA<sub>125</sub> >= 20 and age >= 60, were found to be statistically significant. Indeed, patients possessing all of them noted much poorer outcomes regarding OS factors: 89 days versus 235 days for the other patients (log rank test P = 0.02). <br><b>Conclusions: </b>Our study fortifies the evidence that preoperative levels of CA<sub>19-9</sub> and CA<sub>125</sub> have a direct influence on the longterm OS. Interestingly, in our patient group, the correlation of biomarkers with OS was higher than that of resectability. However, our study has some limitations regarding, for instance, the lack of data on chemotherapy, comorbidities etc. In the view of recent molecular studies on mucin involvement in PC development, it provides a strong clinical evidence to prove their importance.