CA 19–9 predicts resectability of pancreatic cancer even in jaundiced patients

Background

Surgical resection remains the only curative option for pancreatic adenocarcinoma. Despite recent improvements in medical imaging, unresectability is still often discovered at the time of surgery. It is essential to identify unresectable patients preoperatively to avoid unnecessary surgery. High serum CA 19-9 levels have been suggested as a marker of unresectability but considered inaccurate in patients with hyperbilirubinemia.

Usefulness of CA 19–9 for pancreatic cancer screening in patients with new-onset diabetes

Background: Generally, carbohydrate antigen 19–9(CA 19–9) is not useful for screening pancreatic cancer in the asymptomatic general population. This study aimed to evaluate the utility of CA 19–9 level as a screening indicator of pancreatic cancer in asymptomatic patients with new-onset diabetes.Methods: We retrospectively reviewed the medical records of patients who visited our health promotion center for health check-ups without cancer related symptoms from January 2005 to January 2014, and were newly diagnosed with diabetes mellitus(DM) within 2 years before their visit.Results: Of the 5111 asymptomatic patients with new-onset DM(2 years) selected for analyses, 87(1.7%) eventually developed pancreatic cancer after the health check-up. In the subgroup of 322 patients with high total bilirubin levels(1.7 mg/d L) at the screening time, 42(73.7%) of 57 patients with high CA19–9 levels(37 IU/m L) had been diagnosed as pancreatic cancer during follow-up period and 12(4.5%)of 265 patients with normal CA 19–9 levels had finally developed pancreatic cancer(OR = 16.3). In the subgroup of 4789 patients with normal bilirubin levels, pancreatic cancer had been detected in 20(3.8%)of 522 patients with high CA 19–9 level, while only 13(0.3%) in 4267 patients with normal CA 19–9 levels(OR = 12.6), respectively.Conclusion: CA 19–9 levels after a diagnosis of new-onset DM could be a useful biomarker of pancreatic cancer, especially in patients with high serum bilirubin.     

Serum level of TSGF,CA242 and CA19-9 in pancreatic cancer

AIM:To establish a method to detect the expression of thetumor specific growth factor TSGF,CA242 and CA19-9 in serumand evaluate their value in diagnosis of pancreatic cancer.METHODS:ELISA and Biochemical colorimetric assay wereused to detect the serum content of TSGF,CA242 andCA19-9 in 200 normal cases,52 pancreatitis patients and96 pancreatic cancer patients.RESULTS:The positive likelihood ratios of TSGF,CA242and CA19-9 were 5.4,12.6 and 6.3,respectively,and theirnegative likelihood ratios were 0.10,0.19 and 0.17,respectively.With single tumor marker diagnosed pancreaticcancer,the highest sensitivity and specificity of TSGF were91.6% and 93.5%.In combined test with 3 markers,whenall of them were positive,the sensitivity changed to 77.0%and the specificity and the positive predictive value were100%.The levels of TSGF and CA242 were significantly higherin the patients with pancreatic cancer of head than those inthe patients with pancreatic cancer of body,tail and wholepancreas,but the expression of CA19-9 had no correlationwith the positions of the pancreatic cancer.The sensitivityof TSGF,CA242 and CA19-9 was increased with the progressin stages of pancreatic cancer.In stage Ⅰ,the sensitivity ofTSGF was markedly higher than CA242 and CA19-9.CONCLUSION:The combined use of TSGF,CA242 and CA19-9 expressions can elevate the specificity for pancreatic cancerdiagnosis.And it shows that it plays an important role todifferentiate positions and tissue typing.It is a forepartdiagnosis for the pancreatic cancer by combination checking.There is very important correlation between the three markersand the pancreatic cancer.     

Is CA19-9 effective in predicting chemotherapeutic response in patients with synchronous liver metastases with colorectal cancer?

Evaluation of response to chemotherapy in colorectal cancer patients with synchronous liver metastases is important in terms of treatment management.In this Letter to the Editor,several issues in the article are discussed.For the comparison of carbohydrate antigen 19-9(CA19-9)values referenced in the study,the patient group was not matched for cancer stage.Therefore,it may be more appropriate to select and compare CA19-9 values in patients with same-stage cancer.     

Clinical implications of the serum CA19-9 level in “biological borderline resectability” and “biological downstaging” in the setting of preoperative chemoradiation therapy for pancreatic cancer

BackgroundBiological factors are emphasized in borderline resectable pancreatic cancer (BRPC), and CA19-9 is an important factor for biological borderline resectability (b-BR). The aim of this study was to investigate the cut-off value of CA19-9 for biological borderline resectability and “biological downstaging” in chemoradiation therapy (CRT) for pancreatic cancer (PC).MethodsA total of 407 patients with anatomically resectable PC (a-R) and BRPC (a-BR) received preoperative gemcitabine-based CRT. The b-BR was determined, according to the CA19-9 value prior to preoperative CRT (pre-CA19-9), as the subgroup of a-R cases in which the survival was comparable with that in a-BR cases. “Biological downstaging” was determined based on prognostic analyses regarding the CA19-9 value after preoperative CRT (post-CA19-9) in association with the survival of R cases (a-R cases without the b-BR factor).ResultsThe 5-year survival of a-R patients with pre-CA19-9 > 120 U/mL was comparable with that of a-BR patients (44% vs 34%, p = 0.082). The survival of b-BR patients with post-CRT CA19-9 ≤ 37 U/mL (normalized) was comparably favorable with that of R patients (56% vs 65%, p = 0.369). The incidence of distant recurrence was higher in b-BR patients without post-CA19-9 normalization than in those with post-CA19-9 normalization (70% vs 50%, p = 0.003), while the incidence of local recurrence was comparable between these two groups (12% vs 13%, p = 0.986).ConclusionsBiological BRPC was determined to be an anatomically resectable disease with pre-CA19-9 > 120 U/mL, and post-CA19-9 normalization indicated “biological downstaging” in b-BR in the preoperative CRT strategy.