UTILITY OF CA 19-9 AND CEA IN DETERMINING RESECTABILITY OF PANCREATIC CANCER
Abstract
Background: Pancreatic cancer considered as a ‘silent killer’ is usually diagnosed at the late stage of its course. Therefore, the accurate determination of its resectability is the most important contribution to reduce needless surgery to a minimum.
Objective: The aim of the study was to assess the utility of serum CA 19-9, CEA in determining resectability of pancreatic cancer.
Methods: This was a prospective observational study among purposively selected 54 patients diagnosed as pancreatic cancer in Dhaka Medical College Hospital (DMCH) from 1st July 2016 to 31st June 2017. The patients were evaluated by history, physical examination and investigations. The patients were considered to have potentially resectable tumour after assessment. The patients were undergoing surgery for potential tumour resection at the operation theater. Statistical analyses of the results were be obtained by using window-based Microsoft Excel and Statistical Packages for Social Sciences.
Results: This study shows 59.26% (32) patients were in >60 years age group. 62.96% (34) patients were male out of total 54 patients. 98.15% (53) patient had jaundice, 96.30% (52) had weight loss. There was no significant association between CA 19-9, CEA with age, sex and clinical features. Out of the 54 patients, 45 patients were resectable pancreatic carcinoma and 9 patients was unresectable. In this study sensitivity was 88.9%, specificity was 55.6%, PPV was 90.9% and NPV was 50% for CA 19-9. In CEA, sensitivity 77.78%, specificity was 55.56%, PPV was 89.74% and NPV was 33.33%.
Conclusion: The study revealed that lower level of CA 19-9 and CEA can be utilized to determine resectiablity in patients with pancreatic carcinoma with a good positive predictive value.
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References
Carbognin G, Pinali L, Procacci C. Pancreatic Neoplasms and Tumor-like Conditions. InRadiologic-Pathologic Correlations from Head to Toe: Understanding the Manifestations of Disease 2005 (pp. 409-446). Berlin, Heidelberg: Springer Berlin Heidelberg.
Lowenfels AB, Maisonneuve P. Epidemiology and risk factors for pancreatic cancer. Best practice & research Clinical gastroenterology. 2006 Apr 1;20(2):197-209.
Baulieux J, Delpero JR. Surgical treatment of pancreatic cancer: curative resections. In Annales de Chirurgie 2000 Sep 1 (Vol. 125, No. 7, pp. 609-617).
Sharma C, Eltawil KM, Renfrew PD, Walsh MJ, Molinari M. Advances in diagnosis, treatment and palliation of pancreatic carcinoma: 1990-2010. World journal of gastroenterology: WJG. 2011 Feb 2;17(7):867.
Neoptolemos JP, Stocken DD, Dunn JA, Almond J, Beger HG, Pederzoli P, Bassi C, Dervenis C, Fernandez-Cruz L, Lacaine F, Buckels J. Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial. Annals of surgery. 2001 Dec 1;234(6):758-68.
Beger HG, Rau B, Gansauge F, Leder G, Schwarz M, Poch B. Pancreatic cancer–low survival rates. Deutsches Ärzteblatt International. 2008 Apr;105(14):255.
Schlieman MG, Ho HS, Bold RJ. Utility of tumor markers in determining resectability of pancreatic cancer. Archives of surgery. 2003 Sep 1;138(9):951-6.
Olivié D, Lepanto L, Billiard JS, Audet P, Lavallée JM. Predicting resectability of pancreatic head cancer with multi-detector CT. Surgical and pathologic correlation. Jop. 2007 Nov 9;8(6):753-8.
Appukuttan A. Assessment of resectability in carcinoma pancreas using multi-detector computed tomography with surgical correlation. International Surgery Journal. 2016 Dec 8;3(2):701-6.
Holly EA, Chaliha I, Bracci PM, Gautam M. Signs and symptoms of pancreatic cancer: a population-based case-control study in the San Francisco Bay area. Clinical Gastroenterology and Hepatology. 2004 Jun 1;2(6):510-7.
Aziz AM, Said T, Poovathumkadavil A, Almulla A. Using Multidetector CT in Predicting Resectability of Pancreatic Head Tumors: Surgical and Pathologic Correlation. Journal of the Egyptian National Cancer Institute. 2010 Dec 1;22(4):233-9.
Artinyan A, Soriano PA, Prendergast C, Low T, Ellenhorn JD, Kim J. The anatomic location of pancreatic cancer is a prognostic factor for survival. Hpb. 2008 Oct 1;10(5):371-6.
Kiliç M, Göçmen E, Tez M, Ertan T, Keskek M, Koç M. Value of preoperative serum CA 19-9 levels in predicting resectability for pancreatic cancer. Canadian journal of surgery. 2006 Aug;49(4):241.
Fujioka S, Misawa T, Okamoto T, Gocho T, Futagawa Y, Ishida Y, Yanaga K. Preoperative serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels for the evaluation of curability and resectability in patients with pancreatic adenocarcinoma. Journal of hepato-biliary-pancreatic surgery. 2007 Nov; 14:539-44.
Zhang S, Wang YM, Sun CD, Lu Y, Wu LQ. Clinical value of serum CA19-9 levels in evaluating resectability of pancreatic carcinoma. World journal of gastroenterology: WJG. 2008 Jun 6;14(23):3750.
Distler M, Pilarsky E, Kersting S, Grützmann R. Preoperative CEA and CA 19-9 are prognostic markers for survival after curative resection for ductal adenocarcinoma of the pancreas–a retrospective tumor marker prognostic study. International journal of surgery. 2013 Dec 1;11(10):1067-72.
