Prognostic Value of Preoperative Serum CA19-9 in Jaundiced Patients with Primary Resection of Pancreatic Head Adenocarcinoma – Analysis of the German StuDoQ/Pancreas Registry

Abstract

Introduction: Pancreatic carcinoma patients with preoperative CA19-9 serum levels above 500U/ml are classified borderline resectable (BR-B). Up to date, the impact of jaundice on preoperative CA19-9 serum levels has remained unquantified in these patients. Methods: Data on oncologic pancreatic head resections (n=3.079) due to pancreatic carcinoma and prospectively acquired by the German Study, Documentation, and Quality (StuDoQ) registry were analyzed in relation to preoperative CA19-9 and bilirubin serum values. Preoperative CA19-9 values were corrected according to the results of a multivariable linear regression analysis of pathological parameters, bilirubin and CA19-9 values. The impact of CA19-9 adjustment on patient outcome was validated in a second patient cohort (n=345). Results: 420 (24.5%) out of 1703 PDAC patients presented with a preoperative CA19-9 > 500U/ml. While ROC-Analysis failed to determine exact CA19-9 cut-off values for prognostic indicators (R and N-Status), T-, N-, G-Status, UICC-stage and the number of simultaneous vein resections increased with the level of preoperative CA19-9, independent of concurrent jaundice. After adjustment of preoperative CA19-9 values, 18.5% of patients initially staged BR-B showed CA19-9 values below 500U/ml in the registry group. Overall and disease-free-survival of BR-B PDAC patients did not change after CA19-9 correction compared to the raw values (median 19 vs. 10, p<0.001 and 12 vs. 6 months, p<0.001). Conclusions: In this multicenter dataset of PDAC patients, elevation of preoperative CA19-9 correlates with well-defined prognostic pathological parameters. Moreover, this study provides a new CA19-9 correction formula to increase the prognostic value of preoperative CA19-9 serum values in jaundiced patients.