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Prognostic Value of Preoperative Serum Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 After Resection of Ampullary Cancer

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The purpose of this study is to investigate the prognostic value of pre-resection serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 after resection of ampullary cancer (AC) in consideration of intestinal (IT) and pancreatobiliary (PT) subtypes.

Methods

Overall survival (OS) analysis of patients undergoing curative resection of ampullary cancer.

Results

Elevated preoperative CEA (P = 0.013) and CA 19-9 levels (P = 0.030) were significant prognostic factors. Subgroup analysis, however, showed both markers having prognostic value only for the IT subgroup. Pre-resection CEA within normal range identified a subgroup of IT patients with an excellent median survival of 145 months. Compared to other AC patients, this low-risk ITCEA − subpopulation was characterized by less frequent advanced pT stages (pT3/pT4, 41 vs. 62%; P = 0.047) and lymph node involvement (pN+, 30 vs. 65%; P = 0.001). OS of this subgroup was significantly better compared to other AC patients (145 vs. 25 months; HR = 3.8; P < 0.001). By multivariate survival analysis, the patient age, the PT subtype, and an elevated pre-resection serum CEA value were identified as independent prognostic variables.

Conclusions

In AC, the histomorphologic subclassification is highly relevant regarding the prognostic value of preoperative serum CEA and CA 19-9. IT-patients with normal preoperative CEA represent a favorable subgroup with excellent long-term survival.

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Acknowledgments

The authors appreciate the help of Sabrina Karst for her dedicated data acquisition.

Author information

Authors and Affiliations

  1. Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, University of Munich, Campus Grosshadern, Munich, Germany

    Tobias S. Schiergens, Bernhard W. Renz, Rami Al-Sayegh, Hanno Nieß, Matthias Ilmer, Jens Werner & Axel Kleespies

  2. Department of Pathology, University of Munich, Munich, Germany

    Simone Reu & Jens Neumann

  3. Department of Medical Oncology, University of Munich, Campus Grosshadern, Munich, Germany

    Stephan Kruger, Stefan Boeck & Volker Heinemann

Authors
  1. Tobias S. Schiergens
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  3. Simone Reu
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Contributions

All authors did significantly contribute to the conception or design of the work and the acquisition, analysis, and interpretation of data. All authors critically revised the final manuscript. All authors approved the final version of the manuscript to be published. All authors agree to be accountable for all aspects of the work.

Particular/additional contributions:

Tobias S. Schiergens: initiation of the study, mainly designing the study, drafting the manuscript, and analysis of the data.

Simone Reu and Jens Neumann: designing the study, independent evaluation, and analysis of the pathology samples.

Rami Al-Sayegh: acquisition of data and results interpretation.

Bernhard W. Renz: acquisition of data and results interpretation.

Hanno Nieß: acquisition of data and results interpretation.

Matthias Ilmer: acquisition of data and results interpretation.

Stephan Kruger: acquisition of data and results interpretation.

Stefan Boeck: acquisition of data and results interpretation.

Volker Heinemann: acquisition of data and results interpretation.

Jens Werner: acquisition of data and results interpretation.

Axel Kleespies: initiation of the study, designing the study, drafting the manuscript, and analysis of the data.

Corresponding author

Correspondence to Axel Kleespies.

Ethics declarations

Grant Support

No funding was received for the present study.

Ethics Committee

This study was approved by the Ethics Committee of the Ludwig-Maximilians-University of Munich, Germany (UE No 065-13).

Previous Data Publication/Transparency on the Re-use of Data

Characterization, subclassification, and survival of parts of the present patient cohort have been published previously: Schiergens TS et al. Histomorphologic and molecular phenotypes predict gemcitabine response and overall survival in adenocarcinoma of the ampulla of Vater. Surgery 2015 Jul;158(1):151–61. doi: 10.1016/j.surg.2015.02.001. PMID: 25819575.

The actual work represents a relevant expansion and inclusion of new data.

Additional information

Tobias S. Schiergens and Bernhard W. Renz contributed equally to the manuscript.

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Schiergens, T.S., Renz, B.W., Reu, S. et al. Prognostic Value of Preoperative Serum Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 After Resection of Ampullary Cancer. J Gastrointest Surg 21, 1775–1783 (2017). https://doi.org/10.1007/s11605-017-3489-8

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  • DOI: https://doi.org/10.1007/s11605-017-3489-8

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