Role of ca 19-9 as a tumor marker in diagnosis and prognosis of pancreatic carcinoma and cholangiocarcinoma (A study of 46 cases)

  • Dr. Mitsu Vaishnav Assistant Professor, Department of Pathology, Gujarat Adani Institute of Medical Science, Bhuj, Kutchh, Gujarat, India
  • Dr. Sameep Garg Assistant Professor, Department of Pathology, Gujarat Adani Institute of Medical Science, Bhuj, Kutchh, Gujarat, India
  • Dr. Vijay Popat Associate Professor, Department of Pathology, Shri M.P. Shah Medical college, Jamnagar, Gujarat, India
Keywords: CA19-9, Cholangiocarcinoma, Pancreatic Carcinoma, Tumor marker

Abstract

Introduction: Ca19-9 is currently the single most useful tumor marker for diagnosis and prognosis of pancreatic cancer and cholangiocarcinoma.

Aim: The aim is to elucidate the importance of tumor marker ca 19-9 as a diagnostic and prognostic tool in pancreatic carcinoma and cholangio-carcinoma.

Material and Methods: The time period of the study was from september-2012 to september- 2014. The patients were investigated pre-operatively and post operatively for ca 19-9 levels in their serum with the use of ELISA (enzyme linked immunosorbant assay) test.

Results: Total 28 cases of pancreatic lesions were considered which included 24 cases of pancreatic ductal adenocarcinoma, It was observed that when preoperative serum CA 19-9 level was less than 37 u/ml median survival was 28 months. However when CA 19-9 level was more than 200 u/ml, median survival was 6 months. Out of 18 cases studied in gallbladder tumors, 15 cases were of cholangiocarcinoma. Patients with pre-therapy serum CA 19-9 level was between 37 -200 u/ml median survival was 23.25 months. When CA 19-9 level was more than 200 u/ml, median survival was 10.25 months.

Conclusion: Elevated level of ca 19-9 in pancreatic carcinoma and cholangiocarcinoma are associated with higher age group, male sex, higher histological grade, higher TNM staging and metastasis. Post operative ca 19-9 value has definitive prognostic value to detect any metastasis or recurrence in pancreatic carcinoma and cholangio- carcinoma. Therefore it can be concluded that ca 19-9 is an important tumor marker for pancreatic carcninoma and cholangio-carcinoma.

Downloads

Download data is not yet available.

References

Eskelinen M, Haglund U. Developments in serologic detection of human pancreatic adenocarcinoma. Scand J Gastroenterol. 1999 Sep;34(9):833-44.

Herlyn, M.; Sears, H.F.; Steplewski, Z.; Koprowski, H. Monoclonal antibody detection of a circulating tumor-associated antigen. I. Presence of antigen in sera of patients with colorectal, gastric, and pancreatic carcinoma. J. Clin. Immunol. 1982;volume 2 issue 2;135–140.

Audisio RA, Veronesi P, Maisonneuve P, Chiappa A, Andreoni B, Bombardieri E, Geraghty JG. Clinical relevance of serological markers in the detection and follow-up of pancreatic adenocarcinoma. Surg Oncol. 1996 Apr;5(2):49-63.

Aoki H, Ohnishi H, Hama K, Ishijima T, Satoh Y, Hanatsuka K, Ohashi A, Wada S, Miyata T, Kita H, Yamamoto H, Osawa H, Sato K, Tamada K, Yasuda H, Mashima H, Sugano K. Autocrine loop between TGF-beta1 and IL-1beta through Smad3- and ERK-dependent pathways in rat pancreatic stellate cells. Am J Physiol Cell Physiol. 2006 Apr;290(4):C1100-8. Epub 2005 Dec 21.

Okusaka, T.; Okada, S.; Ishii, H.; Nose, H.; Nakasuka, H.; Nakayama, H.; Nagahama, H. Clinical response to systemic combined chemotherapy with 5-fluorouracil and cisplatin (FP therapy) in patients with advanced pancreatic cancer. Jpn. J. Clin. Oncol. 1996;26;215–220.

Tanaka, M.; Chari, S.; Adsay, V.; Fernandez-del Castillo, C.; Falconi, M.; Shimizu, M.; Yamaguchi, K.; Yamao, K.; Matsuno, S. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006, 6(1-2);17–32.

Steinberg W. The clinical utility of the CA 19-9 tumor-associated antigen. Am J Gastroenterol. 1990 Apr;85(4):350-5.

Goonetilleke KS, Siriwardena AK. Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer. Eur J Surg Oncol. 2007 Apr;33(3):266-70. Epub 2006 Nov 9.

Kobayashi, T.; Kawa, S.; Tokoo, M.; Oguchi, H.; Kiyosawa, K.; Furuta, S.; Kanai, M.; Homma, T. Comparative study of CA-50 (time-resolved fluoroimmunoassay), Span-1, and CA19-9 in the diagnosis of pancreatic cancer. Scand. J. Gastroenterol. 1991;volume 26 issue 7; 787–797.

Glenn J, Steinberg WM, Kurtzman SH, Steinberg SM, Sindelar WF. Evaluation of the utility of a radioimmunoassay for serum CA 19-9 levels in patients before and after treatment of carcinoma of the pancreas. J Clin Oncol. 1988 Mar;6(3):462-8.

Hayakawa T, Kondo T, Shibata T, Hamano H, Kitagawa M, Sakai Y, Ono H. Sensitive serum markers for detecting pancreatic cancer. Cancer. 1988 May 1;61(9):1827-31.

Koprowski H, Herlyn M, Steplewski Z, Sears HF. Specific antigen in serum of patients with colon carcinoma. Science. 1981 Apr 3;212(4490):53-5.

Malesci, A., Tommasini, M.A., Bonato, C. et al. Determination of CA19-9 antigen in serum and pancreatic juice for differential diagnosis of pancreatic adenocarcinoma from chronic pancreatitis. Gastroenteroglogy 1987 Jan; 92(1):60.

Safi, F, Roscher, R., Bittner, R., et al. High sensitivity and specificity of CA 19-9 for pancreatic carcinoma in comparison to chronic pancreatitis. Serological and immunohistochemical findings. Pancreas 1987; 2(4):398-403.

Steinberg W. The clinical utility of the CA 19-9 tumor-associated antigen. Am J Gastroenterol. 1990 Apr;85(4):350-5.

Steinberg WM, Gelfand R, Anderson KK, Glenn J, Kurtzman SH, Sindelar WF, Toskes PP. Comparison of the sensitivity and specificity of the CA19-9 and carcinoembryonic antigen assays in detecting cancer of the pancreas. Gastroenterology. 1986 Feb;90(2):343-9.

Takasaki, H., Uchida, E., Tempero, M.A., et al. Correlative study on expression of CA 19-9 and DU-Pan-2 in tumor tissue and in serum of pancreatic cancer patients. Cancer Research 1988 March; 48:1435.

Tatsuta, M., Yamamura, H., Iishi H., et al. Values of CA19-9 in the serum, pure pancreatic juice and aspirated pancreatic material in the diagnosis of malignant pancreatic tumor. Cancer 1985 Dec 1; 56(11):2669-73.

Wang, T.H. Lin, J.W., Chen, D.S., et al. Noninvasive diagnosis of advanced panceatic cancer by real-time ultrasonography, carcinoembryonic antigen, and carbohydrate antigen 19-9. Pancreas 1986; 1(3):219-23.

Strom BL, Maislin G, West SL, et al. Serum CEA and CA19-9: potential future diagnostic or screening tests for gallbladder cancer? Int. J. Cancer 1990 May 15;45(5):821-4.

Dong et al. World Journal of Surgical Oncology 2014;12:171; doi: 10,1186/1477-7819-12-171.

Jiang JT, Wu CP, Deng HF, Lu MY, Wu J, Zhang HY, Sun WH, Ji M. Serum level of TSGF, CA242 and CA19-9 in pancreatic cancer. World J Gastroenterol. 2004 Jun 1;10(11):1675-7.

Pleskow DK, Berger HJ, Gyves J, Allen E, McLean A, Podolsky DK. Evaluation of a serologic marker, CA19-9, in the diagnosis of pancreatic cancer. Ann Intern Med. 1989 May 1;110(9):704-9.

Safi F, Schlosser W, Kolb G, Beger HG. Diagnostic value of CA 19-9 in patients with pancreatic cancer and nonspecific gastrointestinal symptoms. J Gastrointest Surg. 1997 Mar-Apr;1(2):106-12.

Ferrone CR, Finkelstein DM, Thayer SP, Muzikansky A, Fernandez-delCastillo C, Warshaw AL. Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma. J Clin Oncol. 2006 Jun 20;24(18):2897-902.

Kim YC, Kim HJ, Park JH, Park DI, Cho YK, Sohn CI, Jeon WK, Kim BI, Shin JH. Can preoperative CA19-9 and CEA levels predict the resectability of patients with pancreatic adenocarcinoma? J Gastroenterol Hepatol. 2009 Dec;24(12):1869-75. doi: https://doi.org/10.1111/j.1440-1746.2009.05935.x.

Berger AC, Meszoely IM, Ross EA, Watson JC, Hoffman JP. Undetectable preoperative levels of serum CA 19-9 correlate with improved survival for patients with resectable pancreatic adenocarcinoma. Ann Surg Oncol. 2004 Jul;11(7):644-9. Epub 2004 Jun 14.

Waraya M, Yamashita K, Katagiri H, Ishii K, Takahashi Y, Furuta K, et al. Preoperative serum CA19-9 and dissected peripancreatic tissue margin as determiners of long-term survival in pancreatic cancer. Ann Surg Oncol 2009 May;16(5):1231-40.doi: https://doi.org/10.1245/s10434-009-0415-7.

Saad ED, Machado MC, Wajsbrot D, Abramoff R, Hoff PM, Tabacof J, et al. Pretreatment CA 19-9 level as a prognostic factor in patients with advanced pancreatic cancer treated with gemcitabine. Int J Gastrointest Cancer,vol.32,no.1, 2002;35-41.

Stemmler J, Stieber P, Szymala AM, Schalhorn A, Schermuly MM, Wilkowski R, Helmberger T, Lamerz R, Stoffregen C, Niebler K, Garbrecht M, Heinemann V. Are serial CA 19-9 kinetics helpful in predicting survival in patients with advanced or metastatic pancreatic cancer treated with gemcitabine and cisplatin? Onkologie. 2003 Oct;26(5):462-7. [PubMed]

Reni M, Cereda S, Balzano G, Passoni P, Rognone A, Fugazza C, et al. Carbohydrate antigen 19-9 change during chemotherapy for advanced pancreatic adenocarcinoma. Cancer 2009 Jun 15;115(12):2630-9.doi: 10.1002/cncr.24302.

Haglund C, Roberts PJ, Kuusela P, Scheinin TM, Mäkelä O, Jalanko H. Evaluation of CA 19-9 as a serum tumour marker in pancreatic cancer. Br J Cancer. 1986 Feb;53(2):197-202.

Cwik G, Wallner G, Skoczylas T, Ciechanski A, Zinkiewicz K. Cancer antigens 19-9 and 125 in the differential diagnosis of pancreatic mass lesions. Arch Surg. 2006 Oct;141(10):968-73; discussion 974.

Z.Ma et al. An evaluation of the diagnostic value of CA19-9 and CEA levels in patients with pancreatic cancer. Journal of Nanjing Medical University, 2009 may, 23 (3): 199 -202.

Qin XL, Wang ZR, Shi JS, Lu M, Wang L, He QR. Utility of serum CA19-9 in diagnosis of cholangiocarcinoma: in comparison with CEA. World J Gastroenterol. 2004 Feb 1;10(3):427-32.

Jan Harder, Oliver Kummer, Manfred Olschewski, et al. Prognostic Relevance of Carbohydrate Antigen 19-9 Levels in Patients with Advanced Biliary Tract Cancer. Cancer Epidemiol Biomarkers Prev 2007 oct;16(10):2097-2100.

Role of ca 19-9 as a tumor marker in diagnosis and prognosis of pancreatic carcinoma and cholangiocarcinoma (A study of 46 cases)
CITATION
DOI: 10.17511/ijmrr.2017.i05.12
Published: 2017-05-31
How to Cite
1.
Vaishnav M, Garg S, Popat V. Role of ca 19-9 as a tumor marker in diagnosis and prognosis of pancreatic carcinoma and cholangiocarcinoma (A study of 46 cases). Int J Med Res Rev [Internet]. 2017May31 [cited 2024Nov.18];5(5):505-14. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/872
Section
Original Article