Predicting Adverse Pathologic Features and Clinical Outcomes of Resectable Pancreas Cancer With Preoperative CA 19-9

Roman O. Kowalchuk, Scott C. Lester, Rondell P. Graham, William S. Harmsen, Lizhi Zhang, Thorvardur R. Halfdanarson, Rory L. Smoot, Hunter C. Gits, Wen Wee Ma, Dawn Owen, Amit Mahipal, Robert C. Miller, Michelle A.Neben Wittich, Sean P. Cleary, Robert R. McWilliams, Michael G. Haddock, Christopher L. Hallemeier, Mark J. Truty, Kenneth W. Merrell

Research output: Contribution to journalArticlepeer-review


Background: We evaluated preoperative CA 19-9 levels in patients with resected pancreatic cancer to analyze whether they were predictive of clinical outcomes and could help select patients for additional therapy. We hypothesized that elevated CA 19-9 would be associated with worse pathologic findings and oncologic outcomes. Methods: This study assessed 509 patients with non-metastatic pancreatic adenocarcinoma who underwent resection at our institution from 1995-2011 and had preoperative CA 19-9 recorded. No patients received neoadjuvant therapy. CA 19-9 level was analyzed as a continuous and a dichotomized (> vs. ≤ 55 U/mL) variable using logistic and Cox models. Results: Median follow-up was 7.8 years, and the median age was 66 years (33-90). 64% of patients had elevated preoperative CA 19-9 (median: 141 U/mL), that did not correlate with bilirubin level or tumor size. Most patients had ≥ T3 tumors (72%) and positive lymph nodes (62%). The rate of incomplete (R1 or R2) resection was 19%. Increasing preoperative CA 19-9 was associated with extra-pancreatic extension (p=0.0005), lymphovascular space invasion (p=0.0072), incomplete resection [HR (95% CI) 2.0 (1.2-3.5)], and lower OS [HR = 1.6 (1.3-2.0)]. Each doubling in preoperative CA 19-9 value was associated with an 8.3% increased risk of death [HR = 1.08 (1.02-1.15)] and a 10.0% increased risk of distant recurrence [HR = 1.10 (1.02-1.19)]. Patients classified as non-secretors had comparable outcomes to patients with normal CA 19-9. Conclusions: Elevated preoperative CA 19-9 level was associated with adverse pathologic features, incomplete resection, and inferior clinical outcomes. Neither tumor size nor bilirubin confound an elevated CA 19-9 level. Preoperative CA 19-9 level may help select patients for additional therapy.

Original languageEnglish (US)
Article number651119
JournalFrontiers in Oncology
StatePublished - May 11 2021


  • CA19-9
  • neoadjuvant
  • pancreatic cancer
  • prognostic factors
  • resection

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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