Preoperative Value of Serum 19-9 Levels in Predicting Resectability and Prognosis in Pancreatic Cancer

Introduction: The study was aimed at evaluating the value of preoperative CA 19-9 serum level in the prediction of curative resectability in pancreatic cancer and its utility as a prognostic marker. Methods: Data from 200 consecutive patients referred to our Institution for pancreatic cancer were retrospectively revised. Resectability was determined from a complete preoperative clinical and instrumental examination and/or intraoperatively at laparotomy. A ROC curve was constructed for the CA 19-9 levels with the aim to assess the best cut-off value in determining non-curative surgery. Results: There were 84 (42%) resectable and 116 (58%) unresectable pancreatic cancers. The median CA 19-9 level was 59.1 (range 1-9905; IQR 8-233) U/ml in patients submitted to curative resection, 260 (range 6-8496; IQR 113-970) U/mL in non-curative resections, and 684.1 (range 1-63650; IQR 127-5078) U/mL in unresectable group (KW test: p<0.001). ROC analysis identified a cut-off value of 514 U/ml to be associated with curative (R0) resectability (sensitivity 53%, specificity 89%; AUC 0.75). Univariate analyses of 5-year survival revealed that preoperative CA19-9 level was significantly associated with clinical outcome. Discussion: Preoperative CA 19-9 levels, other than a useful prognostic marker, may be valuable in identifying unresectable disease or patients candidate to non-curative surgery