Pre-Operative Ca 19-9 > 90 Is Associated With Worse Overall Survival And Marginal Resection Status In Resectable, Invasive Pancreatic Carcinoma

Purpose/Objective(s)Post-resectional CA 19-9 values > 90 U/mL have been associated with worse survival in resectable pancreatic carcinoma (Regine, ASTRO 2007). We evaluated the pre-operative (preop) CA 19-9 in patients with resectable pancreas cancer as a potential prognostic factor for overall survival (OS) and a predictive factor for pathologic margin status as well as the impact of adjuvant radiation (RT) as a function of CA 19-9.Materials/MethodsA retrospective review of 217 consecutively treated patients who underwent potentially curative resection for (T1-4N0-1M0) invasive carcinoma of the pancreas from 2000 to 2004 at the Mayo Clinic, Rochester, MN, was performed. Patients with indolent histologies and metastases found at surgery were excluded. Seventy patients underwent surgery alone, 139 received RT and/or chemotherapy, and for 8 patients adjuvant therapy administration was unknown. Pathologic margin status was compared using the Fisher exact test. The Kaplan-Meier method was used to estimate OS. Log-rank testing was used to calculate univariate differences in outcomes, and a proportional hazards model was used to estimate relative risk (RR). Multivariate analysis (MVA) was performed using a Cox regression model.ResultsOne hundred thirty-one patients (60%) were followed until death. Median follow-up was 23 months in survivors. Median OS was 19 months. Preop CA 19-9 was available for 146 patients (median 178; range 3-335,300 U/mL). Univariate analysis revealed an association between lower OS and T3/4 stage (RR 1.5, p = 0.03), N+ (RR 1.7, p = 0.03), and CA 19-9 > 90 U/mL (RR 2.0, p = 0.005). MVA revealed an association between lower OS and preop CA 19-9 > 90 U/mL (p = 0.004) only. Positive surgical margin status (R1/R2) was associated with T3/4 stage (29%; p < 0.0001) and CA 19-9 > 90 U/mL (26%; p = 0.01). Adjuvant RT was associated with a greater increase in OS in patients with preop CA 19-9 levels > 180 U/mL compared to those with lower levels (OS 2-yr 41% vs. 19%, RT vs no RT, p = 0.003, for CA 19-9 > 180 U/mL and OS 2-yr 55% vs. 40%, RT vs. no RT, p = 0.14 for patients with preop CA 19-9 < 180 U/mL).ConclusionsPre-operative CA 19-9 values > 90 U/mL are associated with worse prognosis in patients with resectable invasive pancreatic carcinoma and a greater likelihood of positive margin at resection (R1/R2). Adjuvant RT is associated with a relatively greater survival benefit in patients with higher preop CA 19-9 levels. Purpose/Objective(s)Post-resectional CA 19-9 values > 90 U/mL have been associated with worse survival in resectable pancreatic carcinoma (Regine, ASTRO 2007). We evaluated the pre-operative (preop) CA 19-9 in patients with resectable pancreas cancer as a potential prognostic factor for overall survival (OS) and a predictive factor for pathologic margin status as well as the impact of adjuvant radiation (RT) as a function of CA 19-9. Post-resectional CA 19-9 values > 90 U/mL have been associated with worse survival in resectable pancreatic carcinoma (Regine, ASTRO 2007). We evaluated the pre-operative (preop) CA 19-9 in patients with resectable pancreas cancer as a potential prognostic factor for overall survival (OS) and a predictive factor for pathologic margin status as well as the impact of adjuvant radiation (RT) as a function of CA 19-9. Materials/MethodsA retrospective review of 217 consecutively treated patients who underwent potentially curative resection for (T1-4N0-1M0) invasive carcinoma of the pancreas from 2000 to 2004 at the Mayo Clinic, Rochester, MN, was performed. Patients with indolent histologies and metastases found at surgery were excluded. Seventy patients underwent surgery alone, 139 received RT and/or chemotherapy, and for 8 patients adjuvant therapy administration was unknown. Pathologic margin status was compared using the Fisher exact test. The Kaplan-Meier method was used to estimate OS. Log-rank testing was used to calculate univariate differences in outcomes, and a proportional hazards model was used to estimate relative risk (RR). Multivariate analysis (MVA) was performed using a Cox regression model. A retrospective review of 217 consecutively treated patients who underwent potentially curative resection for (T1-4N0-1M0) invasive carcinoma of the pancreas from 2000 to 2004 at the Mayo Clinic, Rochester, MN, was performed. Patients with indolent histologies and metastases found at surgery were excluded. Seventy patients underwent surgery alone, 139 received RT and/or chemotherapy, and for 8 patients adjuvant therapy administration was unknown. Pathologic margin status was compared using the Fisher exact test. The Kaplan-Meier method was used to estimate OS. Log-rank testing was used to calculate univariate differences in outcomes, and a proportional hazards model was used to estimate relative risk (RR). Multivariate analysis (MVA) was performed using a Cox regression model. ResultsOne hundred thirty-one patients (60%) were followed until death. Median follow-up was 23 months in survivors. Median OS was 19 months. Preop CA 19-9 was available for 146 patients (median 178; range 3-335,300 U/mL). Univariate analysis revealed an association between lower OS and T3/4 stage (RR 1.5, p = 0.03), N+ (RR 1.7, p = 0.03), and CA 19-9 > 90 U/mL (RR 2.0, p = 0.005). MVA revealed an association between lower OS and preop CA 19-9 > 90 U/mL (p = 0.004) only. Positive surgical margin status (R1/R2) was associated with T3/4 stage (29%; p < 0.0001) and CA 19-9 > 90 U/mL (26%; p = 0.01). Adjuvant RT was associated with a greater increase in OS in patients with preop CA 19-9 levels > 180 U/mL compared to those with lower levels (OS 2-yr 41% vs. 19%, RT vs no RT, p = 0.003, for CA 19-9 > 180 U/mL and OS 2-yr 55% vs. 40%, RT vs. no RT, p = 0.14 for patients with preop CA 19-9 < 180 U/mL). One hundred thirty-one patients (60%) were followed until death. Median follow-up was 23 months in survivors. Median OS was 19 months. Preop CA 19-9 was available for 146 patients (median 178; range 3-335,300 U/mL). Univariate analysis revealed an association between lower OS and T3/4 stage (RR 1.5, p = 0.03), N+ (RR 1.7, p = 0.03), and CA 19-9 > 90 U/mL (RR 2.0, p = 0.005). MVA revealed an association between lower OS and preop CA 19-9 > 90 U/mL (p = 0.004) only. Positive surgical margin status (R1/R2) was associated with T3/4 stage (29%; p < 0.0001) and CA 19-9 > 90 U/mL (26%; p = 0.01). Adjuvant RT was associated with a greater increase in OS in patients with preop CA 19-9 levels > 180 U/mL compared to those with lower levels (OS 2-yr 41% vs. 19%, RT vs no RT, p = 0.003, for CA 19-9 > 180 U/mL and OS 2-yr 55% vs. 40%, RT vs. no RT, p = 0.14 for patients with preop CA 19-9 < 180 U/mL). ConclusionsPre-operative CA 19-9 values > 90 U/mL are associated with worse prognosis in patients with resectable invasive pancreatic carcinoma and a greater likelihood of positive margin at resection (R1/R2). Adjuvant RT is associated with a relatively greater survival benefit in patients with higher preop CA 19-9 levels. Pre-operative CA 19-9 values > 90 U/mL are associated with worse prognosis in patients with resectable invasive pancreatic carcinoma and a greater likelihood of positive margin at resection (R1/R2). Adjuvant RT is associated with a relatively greater survival benefit in patients with higher preop CA 19-9 levels.