Utility of tumor markers in determining resectability of pancreatic cancer

Michael G. Schlieman, Hung S Ho, Richard J Bold, L. William Traverso, Sherry Wren, Lygia Stewart, Carlos A. Pellegrini

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133 Scopus citations

Abstract

Hypothesis: Despite advances in preoperative radiologic imaging, a significant fraction of potentially resectable pancreatic cancers are found to be unresectable at laparotomy. We tested the hypothesis that preoperative serum levels of CA19-9 (cancer antigen) and carcinoembryonic antigen will identify patients with unresectable pancreatic cancer despite radiologic staging demonstrating resectable disease. Design and Setting: Academic tertiary care referral center. Patients: From March 1, 1996, to July 31, 2002, 125 patients were identified who underwent surgical exploration for potentially resectable pancreatic cancer based on a preoperative computed tomographic scan; in 89 of them a preoperative tumor marker had been measured. Main Outcome Measures: Preoperative tumor markers (CA19-9 and carcinoembryonic antigen) were correlated with extent of disease at exploration. As CA19-9 is excreted in the biliary system, CA19-9 adjusted for the degree of hyperbilirubinemia was determined and analyzed. Results: Of the 89 patients, 40 (45%) had localized disease and underwent resection, 25 (28%) had locally advanced (unresectable) disease, and 24 (27%) had metastatic disease. The mean adjusted CA19-9 level was significantly lower in those with localized disease than those with locally advanced (63 vs 592; P=.003) or metastatic (63 vs 1387; P<.001) disease. When a threshold adjusted CA19-9 level of 150 was used, the positive predictive value for determination of unresectable disease was 88%. Carcinoembryonic antigen level was not correlated with extent of disease. Conclusions: Among the patients with resectable pancreatic cancer based on preoperative imaging studies, those with abnormally high serum levels of CA19-9 may have unresectable disease. These patients may benefit from additional staging modalities such as diagnostic laparoscopy to avoid unnecessary laparotomy.

Original languageEnglish (US)
Pages (from-to)951-956
Number of pages6
JournalArchives of Surgery
Volume138
Issue number9
DOIs
StatePublished - Sep 1 2003

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ASJC Scopus subject areas

  • Surgery

Cite this

Schlieman, M. G., Ho, H. S., Bold, R. J., Traverso, L. W., Wren, S., Stewart, L., & Pellegrini, C. A. (2003). Utility of tumor markers in determining resectability of pancreatic cancer. Archives of Surgery, 138(9), 951-956. https://doi.org/10.1001/archsurg.138.9.951