Serum CA 19-9 in the postsurgical follow-up of patients with pancreatic cancer

In the last few years serum CA 19-9 has been shown to be a highly sensitive marker of pancreatic adenocarcinoma. This study assesses the value of serum CA 19-9 assay in the postsurgical follow-up of patients undergoing pancreatic cancer resection. In 14 patients with cancer in the head of the pancreas and abnormal preoperative serum CA 19-9 values (greater than 40 U/ml), a pancreatoduodenectomy was performed. In all patients the CA 19-9 antigen was immunohistochemically demonstrated on the removed tumoral tissue. Postoperative serum CA 19-9 concentrations were serially measured 15 days after surgery and then every other month. Serum CA 19-9 scores returned to the normal range only in 7 (50%) of the resected patients. All patients with a normal postoperative value and none of those with a persistently elevated one survived longer than 7 months. Early postoperative serum CA 19-9 assay was superior to perioperative staging of the tumor as a prognostic index. All of the seven patients with postoperative normal values exhibited a subsequent increase within 16 months. In all cases the elevation of CA 19-9 occurred at least 2 months before ultrasound (US) could detect local recurrences of hepatic metastasis. Our data indicate that a normal early postoperative CA 19-9 score is a relatively favourable prognostic index in patients who undergo radical surgery for pancreatic cancer and that the CA 19-9 test can be used, as an early marker of recurrence, in monitoring these patients.