Postoperative serum CEA and CA125 levels are supplementary to perioperative CA19-9 levels in predicting operative outcomes of pancreatic ductal adenocarcinoma

Abstract

Carbohydrate antigen (CA19-9) is a well-established marker to monitor disease status after resection of pancreatic cancer. However, few serum markers have been reported to improve the prognostic ability of postoperative CA19-9, especially in patients with normal postoperative CA19-9. A total of 353 patients with pancreatic ductal adenocarcinoma treated by radical resection were reviewed retrospectively, and a prospective cohort including 142 patients with resectable pancreatic head carcinoma was analyzed as a validation cohort. Perioperative CA19-9 and postoperative serum markers (CEA, CA242, CA72-4, CA50, CA125, CA153, and AFP) were investigated. Patients with postoperative normalization of CA19-9 had improved survival times (recurrence-free survival: 11.9months; overall survival: 22.5months) compared with those with decreased but still elevated postoperative CA19-9 (recurrence-free survival: 6.8months, P<.001; overall survival: 13.5months, P<.001) or those with increased postoperative CA19-9 (recurrence-free survival: 3.5months, P<.001; overall survival: 7.9months, P<.001), which was similar to those with consistently normal CA19-9 during perioperative periods (recurrence-free survival: 10.6months, P=.799; overall survival: 24.1months, P=.756). Normal postoperative CA19-9 levels were an independent indicator for a positive outcome after operation, regardless of preoperative CA19-9 levels. Elevated postoperative CEA and CA125 were identified further as independent risk factors for patients with normal postoperative CA19-9, while elevated postoperative CA125 and nondecreased postoperative CA19-9 were independent prognostic markers for patients with elevated postoperative CA19-9. The postoperative monitoring of CEA and CA125 provided prognostic significance to the measurement of CA19-9 in pancreatic cancer after resection.