Kau et al studied prognostic factors including serum CA 19-9 and CEA levels for patients with periampullary carcinoma. The authors are from the National Yang Ming University in Taiwan.
Prognostic factors identified for periampullary carcinoma:
(1) serum CA 19-9
(2) resectability
(3) primary tumor (separated as pancreatic vs nonpancreatic. Nonpancreatic types included tumors of the ampulla of Vater, distal common bile duct, and duodenum; there did not appear to be any islet cell or neuroendocrine tumors).
(4) stage
(5) CEA
(6) tumor size
(7) lymph node involvement
|
Factor |
Finding (Poor vs Good) |
Relative Risk |
95% CI |
p value |
|
serum CA 19-9 |
> 35 U/mL vs <= 35 |
3.25 |
1.59 – 6.36 |
0.0009 |
|
resectability |
unresectable vs resectable |
2.99 |
1.16 – 4.58 |
0.00162 |
|
primary tumor |
pancreatic vs nonpancreatic |
1.33 |
1.07 – 1.61 |
0.0067 |
|
stage |
3 or 4 vs 1 or 2 |
1.51 |
1.06 – 2.02 |
0.0106 |
|
CEA |
> 6 ng/mL vs <= 6 |
1.91 |
0.99 – 2.12 |
0.0676 |
|
tumor size |
> 2 cm vs <= 2 cm |
1.39 |
0.40 – 1.25 |
0.2560 |
|
lymph nodes |
metastasis vs none |
1.08 |
0.60 – 2.14 |
0.8070 |
from Table 4, page 419
where:
• Lymph node involvement has a high p value and overlaps with tumor Stage.
• Tumor size has a high p value and overlaps with resectability and Stage.
CA 19-9 was useful in evaluating patient survival when evaluated relative to resectability of the cancer (from Figures 2 and 3, page 417-418).
|
Resectability |
CA 19-9 <= 35 U/mL |
CA 19-9 > 35 U/mL |
|
resectable |
median survival 36 months with 5 year survival 45% |
median survival 18 months with 5 year survival 19% |
|
unresectable |
median survival 11 months with all dead by 30 months |
median survival about 6 months with all dead by 22 months |
CEA was useful in evaluating patient survival when evaluated relative to resectability of the cancer (from Figures 5 and 6, page 418, which showed unresectable cancers having better survival than resectable tumors).
|
Resectability |
CEA <= 6 ng/mL |
CEA > 6 ng/mL |
|
resectable |
median survival 15 months; 4 year survival 15% |
all patients dead at 10 months |
|
unresectable |
median survival 25 months; 4 year survival 18% |
median survival 6 months; all dead by 26 months |
Specialty: Hematology Oncology, Surgery, general, Gastroenterology
