The value of serum carbohydrate antigen 19-9 as a predictor of resectability in pancreatic adenocarcinoma

Background
Pancreatic cancer is one of the most common causes for cancer-related deaths. Recently, considerable improvements in radiological imaging have made it possible to limit surgery for patients who will benefit. However, ~25-50% of patients with resectable disease on computed tomography (CT) are found to have unresectable lesions at laparotomy. The sensitivity and specificity of carbohydrate antigen 19-9 (CA 19-9) in the diagnosis of pancreatic cancer has been reported to be as high as 90 and 98%, respectively. However, little is known about the value of serum CA 19-9 levels in evaluating the resectability of pancreatic carcinoma.
Aim of the work
The aim of this study was to evaluate the value of serum CA 19-9 level in determining resectability of pancreatic cancer in comparison with triphasic CT.
Patients and methods
This retrospective study included 40 patients with histologically confirmed pancreatic adenocarcinomas. Serum CA 19-9 level was recorded, together with the CT findings. The operative decision as regards resectability was recorded. The level of CA 19-9 in the resectable and irresectable cases was recorded to determine a cutoff value for serum CA 19-9.
Results
Serum CA 19-9 in resectable cases was 182.84 ΁ 219.68, whereas in irresectable cases it was: 1119.60 ΁ 668.66 ( < 0.001). At a cutoff value of 307.55, the sensitivity for resection was 100%, specificity was 88.67%, positive predictive value was 71.43%, the negative predictive value was 100%, and accuracy was 90%.
Conclusion
Preoperative CA 19-9 serum level is a useful marker for further evaluating the resectability of pancreatic adenocarcinoma. Obviously increased serum level of CA 19-9 more than 307.55 U/ml can be regarded as a predictor for unresectable pancreatic cancer. This is beneficial in avoiding unnecessary laparotomy and preventing its morbidity.