Tumor Biology

, Volume 37, Issue 2, pp 1959–1966 | Cite as

Clinical value and impact on prognosis of peri-operative CA 19-9 serum levels in stage I and II adenocarcinoma of the pancreas

  • Riccardo Piagnerelli
  • Daniele Marrelli
  • Giandomenico Roviello
  • Francesco Ferrara
  • Giulio Di Mare
  • Costantino Voglino
  • Roberto Petrioli
  • Mario Marini
  • Raffaele Macchiarelli
  • Franco Roviello
Original Article


CA 19-9 is a marker correlated to the clinical evolution of pancreatic adenocarcinoma. To analyze the clinical value of pre- and postoperative CA 19-9 serum levels in stage I and II pancreatic cancer. We analyzed 61 patients resected for pancreatic cancer. Patients were evaluated about the pre-operative CA 19-9 values and then divided into 3 groups: high, high-low and low, on the basis of pre- and postoperative CA 19-9 levels. The correlations between these groups and age, sex, pT, pN, tumor stage, jaundice, surgical radicality, tumor size, number of harvested and positive lymph nodes, grading, overall and major morbidities and post-operative mortality together with survival rates were analyzed. Higher values of pre-operative CA 19-9 were significantly correlated to the presence of jaundice, high pT, pN, stage and higher number of metastatic lymph nodes. In 49 patients (80.3 %) an R0 resection was performed. Five-year overall survival (OS) and disease free survival (DFS) were significantly better in patients with high levels of pre-operative CA 19-9, even in R0 cases. After stratification, 30 patients were included in the high group, 13 in the high-low group and 18 in the low group. A statistically significant correlation was found between the CA 19-9 groups and the lymph nodal positivity, not between CA 19-9 and pT. OS and DFS were significantly better in low group patients. We confirm the prognostic value of preoperative CA 19-9 serum levels. We do not support early postoperative modifications of CA19-9 as an adjunctive prognostic variable.


Pancreatic cancer Prognostic factors CA 19-9 Pancreatic resection 



None. No funding to declare.


  1. 1.
    Tas F, Sen F, Odabas H, et al. Performance status of patients is the major prognostic factor at all stages of pancreatic cancer. Int J Clin Oncol. 2013;18(5):839–46.CrossRefPubMedGoogle Scholar
  2. 2.
    Chiang KC, Yeh CN, Ueng SH, et al. Clinicodemographic aspect of resectable pancreatic cancer and prognostic factors for resectable cancer. World J Surg Oncol. 2012;10:77.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Altekruse SF, Kosary CL, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2007, National Cancer Institute. 2010;
  4. 4.
    Al-Hawary MM, Francis IR, Chari ST. Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the society of abdominal radiology and the american pancreatic association. Gastroenterology. 2014;146(1):291–304.CrossRefPubMedGoogle Scholar
  5. 5.
    Almadi MA, Alharbi O, Azzam N. Clinical predictors of resectability of pancreatic adenocarcinoma. Saudi J Gastroenterol. 2013;19(6):278–85.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Neuzillet C, Sauvanet A, Hammel P. Prognostic factors for resectable pancreatic adenocarcinoma. J Visc Surg. 2011;148(4):232–43.CrossRefGoogle Scholar
  7. 7.
    Koprowski H, Herlyn M, Steplewski Z, et al. Specific antigen in serum of patients with colon carcinoma. Science. 1981;212:53–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Del Villano BC, Brennan S, Brock P, et al. Radioimmunometric assay for a monoclonal antibody-defined tumor marker, CA19-9. Clin Chem. 1983;29:549–52.PubMedGoogle Scholar
  9. 9.
    Magnani JL, Steplewski Z, Koprowski H, et al. Identification of the gastrointestinal and pancreatic cancer-associated antigen detected by monoclonal antibody 19–9 in the sera of patients as a mucin. Cancer Res. 1983;43:5489–92.PubMedGoogle Scholar
  10. 10.
    Rhodes J. Usefulness of novel tumor markers. Ann Oncol. 1999;10 suppl 4:118–21.CrossRefPubMedGoogle Scholar
  11. 11.
    Ferrone CR, Finkelstein DM, Thayer SP. Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma. J Clin Oncol. 2006;24(18):2897–902.CrossRefPubMedGoogle Scholar
  12. 12.
    Steinberg W. The clinical utility of the CA 19-9 tumor-associated antigen. Am J Gastroenterol. 1990;85:350–5.PubMedGoogle Scholar
  13. 13.
    Sugiura T, Uesaka K, Kanemoto H, et al. Serum CA19-9 is a significant predictor among preoperative parameters for early recurrence after resection of pancreatic adenocarcinoma. J Gastrointest Surg. 2012;16(5):977–85.CrossRefPubMedGoogle Scholar
  14. 14.
    Dong Q, Yang XH, Zhang Y, Jing W, Zheng LQ, Liu YP, et al. Elevated serum CA19-9 level is a promising predictor for poor prognosis in patients with resectable pancreatic ductal adenocarcinoma: a pilot study. World J Surg Oncol. 2014;12:171.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Tian F, Appert HE, Myles J, Howard JM. Prognostic value of serum CA 19-9 levels in pancreatic adenocarcinoma. Ann Surg. 1992;215(4):350–5.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Montgomery RC, Hoffman JP, Riley LB, Rogatko A, Ridge JA, Eisenberg BL. Prediction of recurrence and survival by post-resection CA 19-9 values in patients with adenocarcinoma of the pancreas. Ann Surg Oncol. 1997;4(7):551–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Yang GY, Malik NK, Chandrasekhar R, et al. Change in CA 19-9 levels after chemoradiotherapy predicts survival in patients with locally advanced unresectable pancreatic cancer. J Gastrointest Oncol. 2013;4(4):361–9.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Banz VM, Croagh D, Coldham C, et al. Factors influencing outcome in patients undergoing portal vein resection for adenocarcinoma of the pancreas. EJSO. 2012;38(1):72–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Goonetilleke KS, Siriwardena AK. Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer. EJSO. 2007;33:266–70.CrossRefPubMedGoogle Scholar
  20. 20.
    Berger AC, Garcia Jr M, 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;26:5918–22.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Humphris JL, Chang DK, Johns AL, et al. The prognostic and predictive value of serum CA19.9 in pancreatic cancer. Ann Oncol. 2012;23(7):1713–22.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Kondo N, Murakami Y, Uemura K, et al. Prognostic impact of perioperative serum CA19-9 levels in patients with resectable pancreatic cancer. Ann Surg Oncol. 2010;17(9):2321–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Hata S, Sakamoto Y, Yamamoto Y, et al. Prognostic impact of postoperative serum CA 19-9 levels in patients with resectable pancreatic cancer. Ann Surg Oncol. 2011;19(2):636–41.CrossRefPubMedGoogle Scholar
  24. 24.
    Abdel-Misih SR, Hatzaras I, Schmidt C, et al. Failure of normalization of CA19-9 following resection for pancreatic cancer is tantamount to metastatic disease. Ann Surg Oncol. 2011;18:1116–21.CrossRefPubMedGoogle Scholar
  25. 25.
    Hartwig W, Strobel O, Hinz U, et al. CA19-9 in potentially resectable pancreatic cancer: perspective to adjust surgical and perioperative therapy. Ann Surg Oncol. 2013;20:2188–96.CrossRefPubMedGoogle Scholar
  26. 26.
    Bold RJ. Re: CA 19–9 in potentially resectable pancreatic cancer: perspective to adjust surgical and preoperative therapy. Ann Surg Oncol. 2013;20:2108–10.CrossRefPubMedGoogle Scholar
  27. 27.
    Duffy MJ, Sturgeon C, Lamerz R, et al. Tumor markers in pancreatic cancer: a European Group on Tumor Markers (EGTM) status report. Ann Oncol. 2010;21:441–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Marrelli D, Caruso S, Pedrazzani C, et al. CA19-9 serum levels in obstructive jaundice: clinical value in benign and malignant conditions. Am J Surg. 2009;198:333–9.CrossRefPubMedGoogle Scholar

Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2015

Authors and Affiliations

  • Riccardo Piagnerelli
    • 1
  • Daniele Marrelli
    • 2
    • 6
  • Giandomenico Roviello
    • 3
  • Francesco Ferrara
    • 2
  • Giulio Di Mare
    • 2
  • Costantino Voglino
    • 2
  • Roberto Petrioli
    • 4
  • Mario Marini
    • 5
  • Raffaele Macchiarelli
    • 5
  • Franco Roviello
    • 1
  1. 1.General and Minimally Invasive Surgery UnitUniversity of SienaSienaItaly
  2. 2.Surgical Oncology UnitUniversity of SienaSienaItaly
  3. 3.Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
  4. 4.Oncology UnitUniversity of SienaSienaItaly
  5. 5.Operative Endoscopy UnitUniversity of SienaSienaItaly
  6. 6.SienaItaly

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