Review Article

International Journal of Gastrointestinal Cancer

, Volume 32, Issue 1, pp 35-41

First online:

Pretreatment CA 19-9 level as a prognostic factor in patients with advanced pancreatic cancer treated with gemcitabine

  • Everardo D. SaadAffiliated withCentro Paulista de Oncologia Email author 
  • , Marcel C. MachadoAffiliated withUniversity of São Paulo
  • , Dalia WajsbrotAffiliated withUniversity of São Paulo
  • , Roberto AbramoffAffiliated withCentro Paulista de Oncologia
  • , Paulo M. HoffAffiliated withCentro Paulista de Oncologia
  • , Jacques TabacofAffiliated withCentro Paulista de Oncologia
  • , Artur KatzAffiliated withCentro Paulista de Oncologia
  • , Sergio D. SimonAffiliated withCentro Paulista de Oncologia
  • , René C. GanslAffiliated withCentro Paulista de Oncologia

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access


Background. Serum levels of CA 19-9 correlate with survival among patients with pancreatic cancer treated with surgery or radiation therapy. In addition, CA 19-9 responses have been shown to predict for a better prognosis among patients with advanced disease treated with chemotherapy. The present study evaluates the predictive role of CA 19-9 pretreatment levels and response among patients treated with gemcitabine.

Methods. We retrospectively identified 28 patients with advanced pancreatic cancer and baseline elevations of CA 19-9 (>37 U/mL) who were treated with single agent gemcitabine. CA 19-9 response was defined as a ≥50% decline at any time after treatment. Survival was estimated with the Kaplan-Meier method, and curves were compared with the log-rank test.

Results. Eleven patients (39%) had a CA 19-9 response. The median survival of responding patients was longer than that of non-responding patients (13.8 vs 8 mo, p=.0272). When pretreatment CA 19-9 levels were analyzed, patients who had CA 19-9 below the median for the entire sample (1212 U/mL) lived significantly longer than patients with a CA 19-9 above the median (14.9 vs 7.4 mo, p=.0013). On multivariable analysis, pretreatment CA 19-9 level was an independent, and stronger predictor of survival (p=.0005) than CA 19-9 response (p=.0497). Other variables were not associated with survival.

Conclusions. CA 19-9 may be a useful adjunct to response evaluation is this setting. In addition to CA 19-9 responses, prechemotherapy levels of this marker seem to have strong prognostic significance.

Key Words

Pancreatic neoplasms drug therapy CA 19-9 gemcitabine