Skip to main content

Advertisement

SpringerLink
Log in

Very High Serum CA 19-9 Levels: A Contraindication to Pancreaticoduodenectomy?

  • 2008 SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Aim

To assess the outcome of patients with resectable pancreatic adenocarcinoma (PA) associated with high serum CA 19-9 levels.

Methods

From 2000 to 2007, 344 patients underwent pancreatoduodenectomy for PA. Fifty-three patients (elevated group) had preoperatively elevated serum CA 19-9 levels (>400 IU/ml) after resolution of obstructive jaundice. Of these, 27 patients had high levels (400–899 IU/ml (HL)) and 26 patients had very high levels ≥900 IU/ml (VHL). Fifty patients with normal preoperative serum CA 19-9 levels (<37 IU/ml) comprised the control group.

Results

Median survival of the control group (n = 50) versus elevated group (n = 53) was 22 versus 15 months (p = 0.02) and overall 3-year survival was 32% versus 14% (p = 0.03). There was no statistical difference in the median and 3-year overall survival between patients with HL and VHL. Patients in the elevated group who normalized their CA 19-9 levels after surgery (n = 11) had a survival equivalent to patients in the control group.

Conclusions

Patients who normalized their CA19-9 levels postoperatively had equivalent survival to patients with normal preoperative CA 19-9 levels. Preoperative serum CA 19-9 level by itself should not preclude surgery in patients who have undergone careful preoperative staging.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Ferrone CR, Brennan MF, Gonen M, Coit DG, Fong Y, Chung S, Tang L, Klimstra D, Allen PJ. Pancreatic adenocarcinoma: the actual 5-year survivors. J Gastrointest Surg. 2008;12(4):701–706. doi:10.1007/s11605-007-0384-8.

    Article  PubMed  Google Scholar 

  2. Olivié D, Lepanto L, Billiard JS, Audet P, Lavallée JM. Predicting resectability of pancreatic head cancer with multi-detector CT. Surgical and pathologic correlation. JOP 2007;9;8(6):753–758.

    Google Scholar 

  3. Farma JM, Santillan AA, Melis M, Walters J, Belinc D, Chen DT, Eikman EA, Malafa M. PET/CT fusion scan enhances CT staging in patients with pancreatic neoplasms. Ann Surg Oncol. 2008;15(9):2465–2471. doi:10.1245/s10434-008-9992-0.

    Article  PubMed  Google Scholar 

  4. White R, Winston C, Gonen M, D'Angelica M, Jarnagin W, Fong Y, Conlon K, Brennan M, Allen P. Current utility of staging laparoscopy for pancreatic and peripancreatic neoplasms. J Am Coll Surg. 2008;206(3):445–450. doi:10.1016/j.jamcollsurg.2007.09.021.

    Article  PubMed  Google Scholar 

  5. Karachristos A, Scarmeas N, Hoffman JP. CA 19-9 levels predict results of staging laparoscopy in pancreatic cancer. J Gastrointest Surg. 2005;9:1286–1292. doi:10.1016/j.gassur.2005.06.008.

    Article  PubMed  Google Scholar 

  6. Goonetilleke KS, Siriwardena AK. Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer. Eur J Surg Oncol. 2007;33(3):266–270. doi:10.1016/j.ejso.2006.10.004.

    Article  PubMed  CAS  Google Scholar 

  7. Boeck S, Schulz C, Stieber P, Holdenrieder S, Weckbach S, Heinemann V. Assessing prognosis in metastatic pancreatic cancer by the serum tumor marker CA 19-9: pretreatment levels or kinetics during chemotherapy. Onkologie. 2007;30(1–2):39–42. doi:10.1159/000097764.

    Article  PubMed  CAS  Google Scholar 

  8. Maithel SK, Maloney S, Winston C, Gönen M, D'Angelica MI, Dematteo RP, Jarnagin WR, Brennan MF, Allen PJ. Preoperative CA 19-9 and the yield of staging laparoscopy in patients with radiographically resectable pancreatic adenocarcinoma. Ann Surg Oncol. 2008;15(12):3512–3520. doi:10.1245/s10434-008-0134-5.

    Article  PubMed  Google Scholar 

  9. Ferrone CR, Finkelstein DM, Thayer SP, Muzikansky A, Fernandez-del Castillo C, Warshaw AL. Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma. J Clin Oncol 2006;20;24(18):2897–2902.

    Article  Google Scholar 

  10. Montgomery RC, Hoffman JP, Riley LB, et al. Prediction of recurrence and survival by post-resection CA 19-9 values in patients with adenocarcinoma of the pancreas. Ann Surg Oncol. 1997;4:551–556. doi:10.1007/BF02305535.

    Article  PubMed  CAS  Google Scholar 

  11. Berger AC, Garcia M Jr, Hoffman JP, et al. Postresection CA 19-9 predicts overall survival in patients with pancreatic cancer treated with adjuvant chemoradiation: a prospective validation by RTOG 9704. J Clin Oncol. 2008;26(36):5918–5922. doi:10.1200/JCO.2008.18.6288.

    Article  PubMed  Google Scholar 

  12. Zhang S, Wang YM, Sun CD, Lu Y, Wu LQ. Clinical value of serum CA19-9 levels in evaluating resectability of pancreatic carcinoma. World J Gastroenterol 2008;21;14(23):3750–3753.

    Article  Google Scholar 

  13. Smith RA, Ghaneh P, Sutton R, et al. Prognosis of resected ampullary adenocarcinoma by preoperative serum CA19-9 levels and platelet-lymphocyte ratio. J Gastrointest Surg. 2008;12(8):1422–1428. doi:10.1007/s11605-008-0554-3.

    Article  PubMed  Google Scholar 

  14. Halloran CM, Ghaneh P, Connor S, et al. Carbohydrate antigen 19.9 accurately selects patients for laparoscopic assessment to determine resectability of pancreatic malignancy. Br J Surg. 2008;95(4):453–459. doi:10.1002/bjs.6043.

    Article  PubMed  CAS  Google Scholar 

  15. Ong SL, Garcea G, Thomasset SC, et al. Surrogate markers of resectability in patients undergoing exploration of potentially resectable pancreatic adenocarcinoma. J Gastrointest Surg. 2008;12(6):1068–1073. doi:10.1007/s11605-007-0422-6.

    Article  PubMed  CAS  Google Scholar 

  16. Berger AC, Meszoely IM, Ross EA, et al. Undetectable preoperative levels of serum CA 19-9 correlate with improved survival for patients with resectable pancreatic adenocarcinoma. Ann Surg Oncol. 2004;11(7):644–649. doi:10.1245/ASO.2004.11.025.

    Article  PubMed  Google Scholar 

  17. Nakao A, Oshima K, Nomoto S, Takeda S, Kaneko T, Ichihara T, Kurokawa T, Nonami T, Takagi H. Clinical usefulness of CA-19-9 in pancreatic carcinoma. Semin Surg Oncol. 1998;15:15–22. doi:10.1002/(SICI)1098-2388(199807/08)15:1<15::AID-SSU4>3.0.CO;2-Z.

    Article  PubMed  CAS  Google Scholar 

  18. House MG, Yeo CJ, Cameron JL, Campbell KA, Schulick RD, Leach SD, Hruban RH, Horton KM, Fishman EK, Lillemoe KD. Predicting resectability of periampullary cancer with three-dimensional computed tomography. J Gastrointest Surg. 2004;8(3):280–288. doi:10.1016/j.gassur.2003.12.011.

    Article  PubMed  Google Scholar 

  19. Nieto J, Grossbard ML, Kozuch P. Metastatic pancreatic cancer 2008: is the glass less empty. Oncologist. 2008;13(5):562–576. doi:10.1634/theoncologist.2007-0181, Review.

    Article  PubMed  CAS  Google Scholar 

  20. Magnani JL, Nilsson B, Brockhaus M, et al. A monoclonal antibody-defined antigen associated with gastrointestinal cancer is a ganglioside containing sialylated lacto-N-fucopenteose II. J Biol Chem. 1982;257:14365–14369.

    PubMed  CAS  Google Scholar 

  21. Ritts RE, Pitt HA. CA 19-9 in pancreatic cancer. Surg Oncol Clin N Am. 1998;7:93–100.

    PubMed  CAS  Google Scholar 

  22. Heinemann V, Boeck S. Perioperative management of pancreatic cancer. Ann Oncol. 2008;19(Suppl 7):vii273–vii278. doi:10.1093/annonc/mdn450.

    Article  PubMed  Google Scholar 

  23. Yamaguchi K, Enjoji M, Tsuneyoshi MJ. Pancreatoduodenal carcinoma: a clinicopathologic study of 304 patients and immunohistochemical observation for CEA and CA19-9. Surg Oncol. 1991;47(3):148–154. doi:10.1002/jso.2930470303.

    Article  CAS  Google Scholar 

  24. Nitsche M, Horstmann O, Christiansen H, Hermann RM, Hess CF, Becker H, Pradier O, Schmidberger H. Chemoradioimmunotherapy with 5-fluorouracil, cisplatin and interferon-alpha in pancreatic and periampullary cancer: results of a feasibility study. Cancer Radiother. 2008;12(8):817–821. doi:10.1016/j.canrad.2008.09.009.

    PubMed  CAS  Google Scholar 

  25. Sanchez SE, Trevino JG. Current adjuvant and targeted therapies for pancreatic adenocarcinoma. Curr Med Chem. 2008;15(17):1674–1683. doi:10.2174/092986708784872348, Review.

    Article  PubMed  CAS  Google Scholar 

  26. Hernandez JM, Cowgill SM, Al-Saadi S, Collins A, Ross SB, Cooper J, Villadolid D, Zervos E, Rosemurgy A. CA 19-9 velocity predicts disease-free survival and overall survival after pancreatectomy of curative intent. J Gastrointest Surg. 2009;13(2):349–353. doi:10.1007/s11605-008-0696-3.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    O. Turrini, C. M. Schmidt, J. Moreno, P. Parikh, J. M. Matos, M. G. House, N. J. Zyromski, A. Nakeeb, H. A. Pitt & K. D. Lillemoe

  2. Departments of Surgery, Biochemistry, and Molecular Biology, Cancer Research Institute, 1044 Walnut Street, Room R4-039, Indianapolis, IN, 46202, USA

    C. M. Schmidt

Authors
  1. O. Turrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. M. Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Moreno
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Parikh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. M. Matos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. G. House
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. N. J. Zyromski
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Nakeeb
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. H. A. Pitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. K. D. Lillemoe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. M. Schmidt.

Additional information

Turrini and Schmidt contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Turrini, O., Schmidt, C.M., Moreno, J. et al. Very High Serum CA 19-9 Levels: A Contraindication to Pancreaticoduodenectomy?. J Gastrointest Surg 13, 1791–1797 (2009). https://doi.org/10.1007/s11605-009-0916-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-009-0916-5

Keywords

Search

Navigation