Predictive and prognostic value of CA 19-9 in resected pancreatic adenocarcinoma

Background Preoperative serum values of CA 19-9 have been reported to be associated with survival in patients undergoing resection of pancreatic adenocarcinoma. Hypothesis Preoperative CA 19-9 levels are associated with margin and/or lymph node status in patients undergoing pancreatoduodenectomy for pancreatic carcinoma. Methods We conducted a review of 143 patients undergoing pancreatoduodenectomy for pancreatic adenocarcinoma from July 2001 through April 2006 at our institution. Preoperative serum values of CA 19-9 and total bilirubin, pathologic findings, and survival were analyzed. A cutoff value for CA 19-9 (120 U/ml) was determined using a Cox proportional hazards model for survival. Results Overall survival at 1, 3, and 5 years for patients with CA 19-9≤120 U/ml was 76%, 41%, and 31%, respectively, versus 64%, 17%, and 10% for patients with CA 19-9>120 U/ml (p=0.002). CA 19-9>120 U/ml was not associated, however, with a greater chance of an R1 or R2 resection (p=0.86), tumor involving the SMA margin (p=0.88), tumor at the portal vein groove (p=0.14), or lymph node metastases (p=0.89). Conclusions Our findings do not support a cutoff value for CA 19-9 that is associated with margin or lymph node involvement. Preoperative CA 19-9≤120 U/ml is, however, associated with increased overall and recurrence-free survival.