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Comparison of the Prognostic Impact of Perioperative CA 19-9, Span-I and Dupan II Levels in Patients With Resectable Pancreatic Carcinoma
Naru Kondo*, Yoshiaki Murakami, Kenichiro Uemura, Yasushi Hashimoto, Naoya Nakagawa, Hayato Sasaki, Taijiro Sueda
Surgery, Hiroshima Univ, Hiroshima, Japan
Background: Although serum carbohydrate antigen 19-9 (CA19-9), s-pancreas antigen-1 (SPan-1) and duke pancreatic monoclonal antigen type 2 (DUPAN-2) are commonly utilized tumor markers in pancreatic ductal adenocarcinoma (PDAC), it is still unclear which is the most useful tumor marker for predicting prognosis after surgical resection.
Purpose: The aim of this study was to compare the prognostic impact of perioperative serum CA19-9, SPan-1 and DUPAN II levels in patients with resectable PDAC.
Methods: Of a total of 230 consecutive patients who underwent surgical resection for PDAC, preoperative CA19-9, SPan-1 and DUPAN II levels were available in 189 patients, and both pre- and postoperative CA19-9, SPan-1 and DUPAN II levels were available in 142 patients. Preoperative CA19-9, SPan-1 and DUPAN II levels were analyzed to compare the diagnostic value for resectable PDAC. Moreover, the relationships of clinicopathological factors including pre- and postoperative CA19-9, SPan-1 and DUPAN II levels with overall survival (OS) were analyzed with univariate and multivariate analyses in 142 patients.
Results: Preoperative Span-1 levels were significantly correlated with preoperative SPan-1 levels (r = 0.85, p < 0.001), whereas preoperative DUPAN II levels were not (r = 0.12, p = 0.10). Of the 189 patients with resectable PDAC, elevated preoperative CA19-9 (> 37 U/ml), SPan-1 (> 30 U/ml) and DUPAN II (> 150 U/ml) levels were found in 113 (60%), 96 (51%) and 82 (43%) patients, respectively. Univariate analysis revealed that absent of postoperative adjuvant chemotherapy (p = 0.0002), R1 resection (p = 0.01), higher histological grade (p = 0.007), more advanced UICC pT stage (p = 0.04) and lymph node metastasis (p = 0.004) were significantly associated with worse OS. In addition, significant worse OS were found in patients with higher preoperative CA19-9 (>200 U/ml, p = 0.002), SPan-1 (> 50 U/ml, p = 0.0005) and DUPAN II (> 300 U/ml, p = 0.001), and in those with elevated postoperative CA19-9 (>37 U/ml, p < 0.0001), SPan-1 (> 30 U/ml, p = 0.004) and DUPAN II (> 150 U/ml, p = 0.006). In multivariate analysis, absent of postoperative adjuvant chemotherapy (hazard ratio [HR], 4.47: 95% confidence interval [CI], 1.83 - 10.04; P = 0.001), higher histological grade (Grade 2/3) (HR, 2.71; 95% CI, 1.41 - 5.45; p = 0.002), R1 resection (HR, 2.14; 95% CI, 1.19 - 3.78; p = 0.01) and elevated postoperative CA19-9 (> 37 IU/ml) (HR, 4.70; 95% CI, 1.99 - 10.71; p = 0.0006) were identified as independent predictors for worse OS.
Conclusion: When the prognostic impacts of perioperative serum CA19-9, SPan-1 and DUPAN II levels in patients with resectable PDAC were compared, elevated postoperative CA19-9 (> 37 IU/ml) would be the strongest predictive marker of poor survival in the perioperative period, which may contribute to establishment of new therapeutic strategy.
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