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Predictive Value of Serum Carbohydrate Antigen 19-9 (CA19-9) for Early Mortality in Advanced Pancreatic Cancer

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Abstract

Introduction

Levels of carbohydrate antigen 19-9 (CA19-9) in metastatic pancreatic cancer are used in daily practice as a marker of response to chemotherapy. The association between CA19-9 levels and mortality remains uncertain. This study sought to determine the most accurate level of CA19-9 associated with early mortality, both at diagnosis and during the course of metastatic disease.

Methods

This research is a retrospective analysis of 64 patients with metastatic adenocarcinoma of the pancreas evaluated from January 2010 to December 2015. A receiver-operating characteristic (ROC) curve analysis was performed to evaluate the CA19-9 value and the association with early death (death within 2 months after diagnosis of advanced disease). The survival analysis was estimated by the Kaplan-Meier method, and variables of interest were assessed by proportional hazards regression Cox models.

Results

The mortality rate was 92.2%, and the estimated median survival was 11.0 months. For the ROC curve analysis of initial CA19-9, an area under the curve of 0.868 (95% confidence interval 0.782 to 0.954) was obtained; the cutoff of 2504 U/ml had a sensitivity of 100% and specificity of 82.8% for early death. The effect of initial CA19-9 and chemotherapy contributed independently to the survival time, and every increase of 1000 CA19-9 units increased the risk of death by 9% (p = 0.0003).

Conclusion

CA19-9 levels in advanced pancreatic adenocarcinoma are associated independently with worse prognosis and early death. CA19-9 levels could be considered as a stratification factor for future clinical trials.

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Authors and Affiliations

  1. Oncology Department, Hospital Israelita Albert Einstein, 627/701 Av. Albert Einstein, Morumbi, Sao Paulo, CEP 05651-901, Brazil

    Pedro L. S. Usón Junior, Donato Callegaro-Filho, Diogo D. G. Bugano, Fernando Moura & Fernando C. Maluf

  2. Centro Oncológico Antônio Ermírio de Moraes, Beneficência Portuguesa de São Paulo, 965 R. Martiniano de Carvalho, São Paulo, CEP: 01323-001, Brazil

    Fernando C. Maluf

Authors
  1. Pedro L. S. Usón Junior
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  2. Donato Callegaro-Filho
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  3. Diogo D. G. Bugano
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  4. Fernando Moura
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  5. Fernando C. Maluf
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Corresponding author

Correspondence to Pedro L. S. Usón Junior.

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Conflict of Interest

The authors declare that they have no conflict of interest.

This project was approved by the ethical and research committee (CAAE: 53649216.3.0000.0071).

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Usón Junior, P.L.S., Callegaro-Filho, D., Bugano, D.D.G. et al. Predictive Value of Serum Carbohydrate Antigen 19-9 (CA19-9) for Early Mortality in Advanced Pancreatic Cancer. J Gastrointest Canc 49, 481–486 (2018). https://doi.org/10.1007/s12029-017-0007-x

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  • DOI: https://doi.org/10.1007/s12029-017-0007-x

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