Prognostic impact of carbohydrate antigen 19-9 level at diagnosis in resected stage I-III pancreatic adenocarcinoma

A U.S. population study

Katelin A. Mirkin, Christopher S. Hollenbeak, Joyce Wong

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Pancreatic adenocarcinoma is a highly aggressive cancer, with surgical resection and systemic therapy offering the only hope for long-term survival. Carbohydrate antigen 19-9 (CA 19-9) has been used as a prognostic marker after resection; however, the relationship between survival and pre-treatment CA 19-9 level remains unclear. This study evaluates pre-treatment serum CA 19-9 level as a predictor for long-term survival. Methods: The U.S. National Cancer Data Base [2004-2012] was reviewed for patients with clinical stages I-III resected pancreatic adenocarcinoma with recorded pre-treatment CA 19-9 levels (U/mL). Kaplan Meier and Weibull survival analyses were performed. Results: Four thousand seven hundred and one patients were included: 12.6% received neoadjuvant therapy (NAT), 27.4% underwent surgery, and 60.1% underwent surgery and adjuvant therapy. Amongst those who underwent initial surgery, there was no association between CA 19-9 levels ≤00 (≤100, 101-300, 301-500, 501-800) with survival (stage I P=0.7592, stage II P=0.5088, stage III P=0.9037). Levels > 800 were associated with significantly worse survival in all stages (P≤0.0001, all). Amongst those who received NAT, levels > 800 were associated with worse survival in early (stage I P=0.0001), but not advanced stage disease (stage II P=0.1891, stage III P=0.9316). In multivariable analyses, levels > 800 demonstrated a 3.29 greater hazard of mortality with respect to patients with levels ≤100 (P < 0.0001). Conclusions: Pre-treatment CA 19-9 levels > 800 appear to be associated with advanced disease, and are negatively associated with long-term survival. However, levels ≤800 had no significant association with survival. Although this study suggests an association, further study is needed to evaluate whether patients with CA 19-9 levels > 800 benefit from NAT.

Original languageEnglish (US)
Pages (from-to)778-788
Number of pages11
JournalJournal of Gastrointestinal Oncology
Volume8
Issue number5
DOIs
StatePublished - Oct 1 2017

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Adenocarcinoma
Carbohydrates
Antigens
Survival
Population
Neoadjuvant Therapy
Therapeutics
Survival Analysis
Neoplasms
Databases
Mortality
Serum

All Science Journal Classification (ASJC) codes

  • Oncology
  • Gastroenterology

Cite this

@article{44b1c0cef3864cf9ba35421eb624e2e2,
title = "Prognostic impact of carbohydrate antigen 19-9 level at diagnosis in resected stage I-III pancreatic adenocarcinoma: A U.S. population study",
abstract = "Background: Pancreatic adenocarcinoma is a highly aggressive cancer, with surgical resection and systemic therapy offering the only hope for long-term survival. Carbohydrate antigen 19-9 (CA 19-9) has been used as a prognostic marker after resection; however, the relationship between survival and pre-treatment CA 19-9 level remains unclear. This study evaluates pre-treatment serum CA 19-9 level as a predictor for long-term survival. Methods: The U.S. National Cancer Data Base [2004-2012] was reviewed for patients with clinical stages I-III resected pancreatic adenocarcinoma with recorded pre-treatment CA 19-9 levels (U/mL). Kaplan Meier and Weibull survival analyses were performed. Results: Four thousand seven hundred and one patients were included: 12.6{\%} received neoadjuvant therapy (NAT), 27.4{\%} underwent surgery, and 60.1{\%} underwent surgery and adjuvant therapy. Amongst those who underwent initial surgery, there was no association between CA 19-9 levels ≤00 (≤100, 101-300, 301-500, 501-800) with survival (stage I P=0.7592, stage II P=0.5088, stage III P=0.9037). Levels > 800 were associated with significantly worse survival in all stages (P≤0.0001, all). Amongst those who received NAT, levels > 800 were associated with worse survival in early (stage I P=0.0001), but not advanced stage disease (stage II P=0.1891, stage III P=0.9316). In multivariable analyses, levels > 800 demonstrated a 3.29 greater hazard of mortality with respect to patients with levels ≤100 (P < 0.0001). Conclusions: Pre-treatment CA 19-9 levels > 800 appear to be associated with advanced disease, and are negatively associated with long-term survival. However, levels ≤800 had no significant association with survival. Although this study suggests an association, further study is needed to evaluate whether patients with CA 19-9 levels > 800 benefit from NAT.",
author = "Mirkin, {Katelin A.} and Hollenbeak, {Christopher S.} and Joyce Wong",
year = "2017",
month = "10",
day = "1",
doi = "10.21037/jgo.2017.07.04",
language = "English (US)",
volume = "8",
pages = "778--788",
journal = "Journal of Gastrointestinal Oncology",
issn = "2078-6891",
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number = "5",

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T1 - Prognostic impact of carbohydrate antigen 19-9 level at diagnosis in resected stage I-III pancreatic adenocarcinoma

T2 - A U.S. population study

AU - Mirkin, Katelin A.

AU - Hollenbeak, Christopher S.

AU - Wong, Joyce

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background: Pancreatic adenocarcinoma is a highly aggressive cancer, with surgical resection and systemic therapy offering the only hope for long-term survival. Carbohydrate antigen 19-9 (CA 19-9) has been used as a prognostic marker after resection; however, the relationship between survival and pre-treatment CA 19-9 level remains unclear. This study evaluates pre-treatment serum CA 19-9 level as a predictor for long-term survival. Methods: The U.S. National Cancer Data Base [2004-2012] was reviewed for patients with clinical stages I-III resected pancreatic adenocarcinoma with recorded pre-treatment CA 19-9 levels (U/mL). Kaplan Meier and Weibull survival analyses were performed. Results: Four thousand seven hundred and one patients were included: 12.6% received neoadjuvant therapy (NAT), 27.4% underwent surgery, and 60.1% underwent surgery and adjuvant therapy. Amongst those who underwent initial surgery, there was no association between CA 19-9 levels ≤00 (≤100, 101-300, 301-500, 501-800) with survival (stage I P=0.7592, stage II P=0.5088, stage III P=0.9037). Levels > 800 were associated with significantly worse survival in all stages (P≤0.0001, all). Amongst those who received NAT, levels > 800 were associated with worse survival in early (stage I P=0.0001), but not advanced stage disease (stage II P=0.1891, stage III P=0.9316). In multivariable analyses, levels > 800 demonstrated a 3.29 greater hazard of mortality with respect to patients with levels ≤100 (P < 0.0001). Conclusions: Pre-treatment CA 19-9 levels > 800 appear to be associated with advanced disease, and are negatively associated with long-term survival. However, levels ≤800 had no significant association with survival. Although this study suggests an association, further study is needed to evaluate whether patients with CA 19-9 levels > 800 benefit from NAT.

AB - Background: Pancreatic adenocarcinoma is a highly aggressive cancer, with surgical resection and systemic therapy offering the only hope for long-term survival. Carbohydrate antigen 19-9 (CA 19-9) has been used as a prognostic marker after resection; however, the relationship between survival and pre-treatment CA 19-9 level remains unclear. This study evaluates pre-treatment serum CA 19-9 level as a predictor for long-term survival. Methods: The U.S. National Cancer Data Base [2004-2012] was reviewed for patients with clinical stages I-III resected pancreatic adenocarcinoma with recorded pre-treatment CA 19-9 levels (U/mL). Kaplan Meier and Weibull survival analyses were performed. Results: Four thousand seven hundred and one patients were included: 12.6% received neoadjuvant therapy (NAT), 27.4% underwent surgery, and 60.1% underwent surgery and adjuvant therapy. Amongst those who underwent initial surgery, there was no association between CA 19-9 levels ≤00 (≤100, 101-300, 301-500, 501-800) with survival (stage I P=0.7592, stage II P=0.5088, stage III P=0.9037). Levels > 800 were associated with significantly worse survival in all stages (P≤0.0001, all). Amongst those who received NAT, levels > 800 were associated with worse survival in early (stage I P=0.0001), but not advanced stage disease (stage II P=0.1891, stage III P=0.9316). In multivariable analyses, levels > 800 demonstrated a 3.29 greater hazard of mortality with respect to patients with levels ≤100 (P < 0.0001). Conclusions: Pre-treatment CA 19-9 levels > 800 appear to be associated with advanced disease, and are negatively associated with long-term survival. However, levels ≤800 had no significant association with survival. Although this study suggests an association, further study is needed to evaluate whether patients with CA 19-9 levels > 800 benefit from NAT.

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U2 - 10.21037/jgo.2017.07.04

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