Abstracts
1997 Digestive Disease Week

Biliary CA 19-9 values correlate with the incidence of hepatic metastasis in patients with adenocarcinoma of the pancreas.

RC Montgomery, JP Hoffman, LB Riley, EA Ross, BL Eisenberg. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA.

While serum values for the tumor associated antigen CA 19-9 are an independent predictor of survival in patients with adenocarcinoma of the pancreas, the utility of biliary CA 19-9 values is unknown. This study was undertaken to determine if biliary CA 19-9 levels predict hepatic metastasis.

Between 1991 and 1996 thirty-eight patients treated for adenocarcinoma of the pancreas had serum and biliary CA 19-9 levels assessed. Serum levels for CA 19-9 were drawn serially beginning in the preoperative period. Biliary samples were obtained from percutaneous biliary stents placed in the preoperative or perioperative period. Five of the thirty-eight patients had low preoperative serum levels of CA 19-9 (< 2 u/ml) and were excluded. Of the remaining thirty-three patients, twenty-two patients underwent pancreatic resection, nine patients had palliative bypass, and two patients had no surgical procedure.

Twenty-seven of the thirty-three patients (80%) developed distant metastasis: five pulmonary, five peritoneal and seventeen hepatic. Of the patients who developed liver metastasis, ten were discovered at the initial exploration and seven developed metastases postoperatively (median interval 10 months). Biliary CA 19-9 values were significantly higher in patients with hepatic metastasis (median 267,400 u/ml; range 34,379 to 5,000,000 u/ml) when compared to patients without metastatic disease (median 34,103 u/ml; range 6,620 to 239,880 u/ml; p< 0.006). Postoperative serum CA 19-9 values correlated with biliary values (p< 0.02). However, in contrast to biliary values, serum values did not predict hepatic metastasis.

Median survival for the entire group of thirty-three patients was 13 months. Patients with hepatic, peritoneal, and pulmonary metastasis had median survivals of 8, 14, and 35 months (p< 0.0041). All patients without metastatic disease are alive (median follow-up 13 months). Biliary CA 19-9 values below 149,490 u/ml were associated with improved disease free survival (13 vs 1 month p< 0.04) and overall survival (21 vs 11 months p< 0.013).

This study demonstrates a possible utility of biliary CA 19-9 values in patients with adenocarcinoma of the pancreas. Patients with CA 19-9 levels greater than 149,490 u/ml are at an increased risk of developing recurrent disease and may warrant further hepatic evaluation or therapy.