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Preoperative Serum CA19-9 and Dissected Peripancreatic Tissue Margin as Determiners of Long-Term Survival in Pancreatic Cancer

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

Abstract

Background

Pancreatic cancer, a particularly deadly form of malignancy, has increased in the last decade worldwide. The purpose of this study is to identify markers for determining and identifying possible long-term survivors in cases of advanced pancreatic cancer.

Patients and methods

117 patients with pancreatic ductal carcinoma, including 89 with invasive tubular adenocarcinoma of the pancreas, Japan Pancreas Society (JPS) stage III–IVb patients, who underwent tumor resection between 1986 and 2006.

Results

Univariate prognostic analyses of the 5-year disease-specific survival (DSS) revealed that JPS stage (P < 0.0001), preoperative serum carbohydrate antigen 19-9 (CA19-9) level (preCA19-9; P < 0.0001), dissected peripancreatic tissue margin (DPM; P < 0.0001), residual tumor (R factor; P = 0.0007), lymph node metastasis density over 10% (ND10; P = 0.006), volume of the stromal connective tissue (stroma factor; P = 0.008), growth pattern (P = 0.01), and histology (P = 0.03) were all significantly associated with poor outcome in advanced pancreatic cancer. Multivariate logistic analysis confirmed that preCA19-9 [P = 0.0006, relative risk (RR) = 2.16] and DPM (P = 0.04, RR = 1.62) were prognostic factors that remained, independent of JPS stage (P = 0.001). The higher preCA19-9 was, the worse the prognosis was. Astonishingly, among JPS stage III cases, 76.9% of the patients with preCA19-9 below 37 U/ml survived more than 5 years. This, combined with an analysis of DPM, allowed us to identify those with the potentiality for long-term survival.

Conclusion

Our results reveal for the first time that it is possible with JPS stage III–IVb invasive tubular adenocarcinomas of the pancreas to differentiate prognostic groups and potential survival rates, like with other cancers.

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Authors and Affiliations

  1. Department of Surgery, Medical School, Kitasato University Hospital, Sagamihara, Kanagawa, Japan

    Mina Waraya MD, Keishi Yamashita MD, PhD, Hiroyuki Katagiri MD, PhD, Kenichiro Ishii MD, PhD, Yoshihito Takahashi MD, PhD, Kazunori Furuta MD, PhD & Masahiko Watanabe MD, PhD, FACS

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  1. Mina Waraya MD
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  2. Keishi Yamashita MD, PhD
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  3. Hiroyuki Katagiri MD, PhD
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  4. Kenichiro Ishii MD, PhD
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  5. Yoshihito Takahashi MD, PhD
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  6. Kazunori Furuta MD, PhD
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  7. Masahiko Watanabe MD, PhD, FACS
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Correspondence to Masahiko Watanabe MD, PhD, FACS.

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Waraya, M., Yamashita, K., Katagiri, H. et al. Preoperative Serum CA19-9 and Dissected Peripancreatic Tissue Margin as Determiners of Long-Term Survival in Pancreatic Cancer. Ann Surg Oncol 16, 1231–1240 (2009). https://doi.org/10.1245/s10434-009-0415-7

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  • DOI: https://doi.org/10.1245/s10434-009-0415-7

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