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The Impact of Carbohydrate Antigen 19-9 on Survival in Patients with Clinical Stage I and II Pancreatic Cancer

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Carbohydrate antigen (CA) 19-9 is a biomarker to monitor treatment effect. A threshold to predict prognostic significance remains undefined. We evaluated the impact of CA19-9 on overall survival (OS) in patients with early-stage pancreatic cancer (PC) utilizing the National Cancer Database (NCDB).

Methods

The NCDB was queried from 2010 to 2014 to identify patients with clinical stage I–II PC. Patients who had undocumented pretreatment CA19-9 were excluded. Patients were stratified into two cohorts: CA19-9 < 98 U/mL and CA19-9 ≥ 98 U/mL, and further categorized into surgery versus no surgery. Twelve- and 24-month OS rates are reported.

Results

Overall, 32,382 patients (stage I: 12,173; stage II: 20,209) were included. The majority of stage I (52.1%) and II (60%) patients had CA19-9 ≥ 98 U/mL. Stage I–II patients with CA19-9 < 98 U/mL had improved OS rates (stage I: 67.5%, 42.6%; stage II: 59.8%, 32.8%) compared with stage I and II patients with CA19-9 ≥ 98 U/mL (stage I: 50.7%, 26.9%; stage II: 48.1%, 22%). Among resected stage I patients, CA19-9 <98 U/mL was associated with improved OS (< 98: 80.5%, 56%; ≥ 98: 70.2%, 42.8%), and a similar trend was seen in resected stage II patients (< 98: 77.6%, 49.9%; ≥ 98: 71%, 39.2%). Unresected stage I patients with lower CA19-9 had improved OS (< 98: 42.1%, 17.5; ≥ 98: 29.9%, 10%), with similar findings in unresected stage II patients (< 98: 41.1%, 15.3%; ≥ 98: 33.4%, 10.6%).

Conclusions

Our study demonstrated the prognostic value of CA19-9 in patients with clinical stage I–II PC, with a value < 98 U/mL demonstrating improved survival. Surgery significantly improved survival at 12 and 24 months irrespective of CA19-9.

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Acknowledgment

Research reported in this publication was supported in part by the Biostatistics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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This work received no direct funding.

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Authors and Affiliations

  1. Department of Surgery, University of Rochester, Rochester, NY, USA

    Alexa D. Melucci MD, MS, Alexander C. Chacon MD, MPH, Paul R. Burchard MD, Vasileios Tsagkalidis MD, Anthony S. Casabianca MD & Darren R. Carpizo MD, PhD

  2. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Subir Goyal PhD & Jeffrey M. Switchenko PhD

  3. Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA

    David A. Kooby MD, Charles A. Staley MD & Mihir M. Shah MD

  4. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA

    Darren R. Carpizo MD, PhD

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Correspondence to Mihir M. Shah MD.

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Disclosures

Darren Carpizo is the founder of Z53 Therapeutics Inc. Alexa D. Melucci, Alexander C. Chacon, Paul R. Burchard, Vasileios Tsagkalidis, Anthony S. Casabianca, Subir Goyal, Jeffrey M. Switchenko, David A. Kooby, Charles A. Staley, and Mihir M. Shah have no disclosures to declare.

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Melucci, A.D., Chacon, A.C., Burchard, P.R. et al. The Impact of Carbohydrate Antigen 19-9 on Survival in Patients with Clinical Stage I and II Pancreatic Cancer. Ann Surg Oncol 29, 8536–8547 (2022). https://doi.org/10.1245/s10434-022-12497-x

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