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.
