CA 19-9 Velocity Predicts Disease-Free Survival and Overall Survival After Pancreatectomy of Curative Intent

Introduction  This study was undertaken to correlate serum CA 19-9 levels and CA 19-9 velocity with disease-free and overall survival after pancreatectomy for adenocarcinoma. Methods  From 1997 to 2002, 96 patients underwent pancreatectomy without adjuvant chemotherapy as the control arm of a large randomized prospective adjuvant therapy trial. After resection, CA 19-9 levels were drawn at baseline, 4 weeks, and 12-week intervals thereafter. CA 19-9 velocity denotes rate of change in CA 19-9 levels over a 4-week period. Postoperative baseline CA 19-9 levels and CA 19-9 velocity were correlated with disease-free and overall survival. Data are presented as median (mean ± SD). Results  Disease-free survival was 7 months (14 ± 13.7), and overall survival was 12 months (19 ± 14.3) with 24 (25%) patients alive at 41 months (39 ± 7.8). Baseline CA 19-9 levels and CA 19-9 velocity predicted disease-free (p < 0.01) and overall survival (p < 0.01). CA 19-9 velocity was a better predictor of overall survival than baseline CA 19-9 (p < 0.001). CA 19-9 velocity at disease progression was 131 U/ml/4-weeks (1,684 ± 4,474.8) vs. 1 U/ml/4-weeks (1 ± 3.8) at 22 months for patients without disease progression (p < 0.001). Conclusions  CA 19-9 velocity predicts imminent disease progression after resection of pancreatic adenocarcinoma and is a better predictor of overall survival than baseline CA 19-9 levels. CA 19-9 velocity is a reliable and relatively inexpensive means of monitoring patients after resection of pancreatic cancer and should be considered in all patients enrolled in clinical trials as well as patients receiving adjuvant therapy.