PROGNOSTIC VALUE OF POST OPERATIVE CA19-9 IN PATIENTS UNDERGOING PANCREATICODUODENECTOMY FOR PANCREATIC ADENOCARCINOMA

IntroductionPancreatic Adenocarcinoma accounts for over 90% of Pancreatic malignancy with overall survival being <5% at 5 years. CA 19-9 is a commonly used tumour marker with levels in excess of 200 U/ml being 90% sensitive for pancreatic malignancy. Pre-operative CA 19-9 has been used as a prognostic marker with higher levels being associated with poorer outcomes. The purpose of this study was to see if post operative Ca19-9 was an independent prognostic factor.MethodsA retrospective analysis of a prospectively collected database from January 2005 to December 2010. Inclusion criteria was a normal preoperative bilirubin and pre and postoperative Ca 19-9 measurements (n=76). The primary endpoint was death or recurrence of disease. Data were also analysed for TNM staging, resection margin status and overall survival.Results70 patients with pancreatic ductal adenocarcinoma were in the study. An elevated post operative CA19-9 (n=33) had a significantly poor mean survival of 26.8 months compared to patients with normal levels (n=37) who had a mean survival of 45.5 months (p=0.004). For patients with a postoperative value ≥200 U/ml (n=13) mean survival was 19.8 months compared with levels <200 U/ml (n=57) being 43.9 months (p=0.001). A <75% fall in post operative ca19-9 levels in comparison to preoperative levels (45 vs 25 patients) resulted in poor mean survival of 34.9 vs 45.9 months but did not reach statistical significance (p=0.218).ConclusionIn patients who have undergone pancreaticoduodenectomy for ductal adenocarcinoma having a normal postoperative Ca 19-9 is a marker for improved outcome where as a level in excess of 200 U/ml is a negative predictive factor. A <75% fall in post operative readings of CA19-9 results in poor survival (11 months) but was not statistically significant.Competing interestsNone declared.