Postoperative CA19-9 Research Articles

Prognostic value of serum CA 19-9 levels in pancreatic adenocarcinoma.

Thirty-eight patients with histologically proven pancreatic adenocarcinoma were investigated to establish the utility of serum CA 19-9 as a prognostic indicator. CA 19-9 assays were performed serially during the course of the disease. In four patients with negative Lewis blood type, the CA 19-9 levels remained essentially normal throughout the disease course. In the remaining 34 patients, (1) CA 19-9 levels were significantly lower in patients with tumor size no larger than 5 cm in diameter, and in patients with resectable tumors than in those with tumor size larger than 5 cm or with unresectable tumors (p less than 0.01). 2) CA 19-9 levels dropped sharply after resection in all 11 resectable patients, whereas no significant change was found after laparotomy without resection. (3) The average survival time in seven patients whose CA 19-9 levels returned to normal after resection was significantly longer than in those four patients with postoperative CA 19-9 levels that decreased but did not return to normal (21.9 versus 8.7 months, p less than 0.05). (4) In 6 of 11 patients who underwent resection, recurrent elevation of CA 19-9 preceded changes detectable by computed tomography or clinical examination by 2 to 9 months. (5) In 23 patients who died of pancreatic carcinoma, 15 (65%) had an obvious rise in CA 19-9 level before death. There was a correlation between the doubling time of the CA 19-9 serum level and survival time (r = 0.5, p less than 0.05). Because it can be demonstrated that the reduction of tumor burden by resection lowers serum CA 19-9 levels, serum CA 19-9 levels may be a useful indicator of whether other forms of treatment such as radiation therapy or chemotherapy also reduce the tumor burden.

Serum CA 19-9 in the postsurgical follow-up of patients with pancreatic cancer.

In the last few years serum CA 19-9 has been shown to be a highly sensitive marker of pancreatic adenocarcinoma. This study assesses the value of serum CA 19-9 assay in the postsurgical follow-up of patients undergoing pancreatic cancer resection. In 14 patients with cancer in the head of the pancreas and abnormal preoperative serum CA 19-9 values (greater than 40 U/ml), a pancreatoduodenectomy was performed. In all patients the CA 19-9 antigen was immunohistochemically demonstrated on the removed tumoral tissue. Postoperative serum CA 19-9 concentrations were serially measured 15 days after surgery and then every other month. Serum CA 19-9 scores returned to the normal range only in 7 (50%) of the resected patients. All patients with a normal postoperative value and none of those with a persistently elevated one survived longer than 7 months. Early postoperative serum CA 19-9 assay was superior to perioperative staging of the tumor as a prognostic index. All of the seven patients with postoperative normal values exhibited a subsequent increase within 16 months. In all cases the elevation of CA 19-9 occurred at least 2 months before ultrasound (US) could detect local recurrences of hepatic metastasis. Our data indicate that a normal early postoperative CA 19-9 score is a relatively favourable prognostic index in patients who undergo radical surgery for pancreatic cancer and that the CA 19-9 test can be used, as an early marker of recurrence, in monitoring these patients.