Prognostic impact of the ratio of preoperative CA19-9 to liver enzyme levels in pancreatic cancer patients with jaundice

Abstract

Introduction: CA19-9 has been reported as a significant predictor for poor prognosis of PDAC but the degree of its elevation could be interfered by obstructive jaundice. To evaluate the predictability of CA19-9 for OS of PDAC patients, we adjusted preoperative serum CA19-9 with liver enzyme levels. Methods: 563 patients undergoing surgery for PDAC in our center were reviewed. Preoperative parameters were recorded as well as OS, which began from the date of operation to that of death or last follow-up. Kaplan-Meier survival curves with log-rank test was applied. Results: The MST was 17.767 months. We used 39/390/1000 as cutoff values of preoperative CA19-9 and Kaplan-Meier survival analysis illustrated significantly different prognosis among patients with TBIL < 102.6 μmol/L (P < 0.001, MST = NR/19.533/15.067/11.200 months). However, this tendency disappeared (P = 0.086) when TBIL >=102.6 μmol/L. We adjusted the CA19-9 level by dividing it by the value of preoperative serumγ-GGT and AST. The optimal cut off values of CA19-9/γ-GGT and CA19-9/ASTwere 0.4 and 0.5, respectively.Value 0 was assigned to the ratio lower than the cutoff value while value 1 to the higher. Add up the values and we found that patients who got 0 tended to have significantly better survival than those valued 1, and patients scored 2 showed the worst survival (P < 0.001, MST = 33.467/17.867/9.800 months). Conclusion: Preoperative serum CA19-9 is a defective predictor for survival of PDAC patients with TBIL ≥102.6 μmol/L but this could be adjusted well by the ratio of CA19-9 to γ-GGT and AST.