Perioperative CA19-9 in potentially resectable pancreatic cancer: New perspectives to individualize therapy

Abstract

Department of General Surgery, University of Heidelberg, Germany Background: In pancreatic cancer, genetic markers to aid clinical decision making are still lacking. The present study aimed to determine the prognostic role of perioperative CA19-9 in pancreatic adenocarcinoma, with a focus on implications for preand postoperative therapeutic consequences. Patients and methods: Of a total of 1627 consecutive patients who underwent surgery for primary pancreatic adenocarcinoma, data from 1543 patients with preoperative serum levels of CA19-9 were evaluated for tumor stage, resectability, and prognosis. Pre-to-postoperative CA19-9 changes were analyzed for long-term survival. A control cohort of 706 patients with chronic pancreatitis was used to assess the predictability of malignancy by CA19-9 and the effects of hyperbilirubinemia on CA19-9 levels. A treatment algorithm including surgical, neoadjuvant, and adjuvant therapy was derived. Results: The more that preoperative CA19-9 increased, the lower were tumor resectability and survival rates. Resectability and 5-year survival varied from 80% to 38% and from 27% to 0% for CA19-9 4000U/ ml, respectively. CA19-9 increased with the stage of the disease and was highest in AJCC stage IV. Patients with postoperatively normal CA19-9 levels or a postoperative CA19-9 decrease of 75% had a superior prognosis (median survival 36.8 and 26months). CA19-9 levels >1000U/ml or postoperatively increasing levelswere associatedwith a dismal R0 resection rate and prognosis. Hyperbilirubinemia did not critically affect CA19-9 levels. Conclusion: In patients with pancreatic adenocarcinoma, perioperative CA19-9 predicts resectability, stage of disease, as well as prognosis, and was not critically affected by hyperbilirubinemia. Highly increased preoperative or increasing postoperative CA19-9 levels are associated with low respectability and poor survival rates, and demand the adaptation of operative and perioperative therapy.