The Use of Tumor Markers to Assess Pancreatic Cancer Resectability

Abstract

Introduction: Pancreatic cancer has the poorest stage-specific survival rate compared to all other solid tumors and is currently the eighth leading cause of cancer-related deaths worldwide. Thus, approximately one-quarter of patients have unresectable tumors found at surgery, potentially resulting in unnecessary laparotomy. The majority of patients have unresectable locally advanced or metastatic disease, and therefore treatment measures are purely palliative in nature. Methods & Materials: This comparative study was conducted from July to December 2022 at the Department of Hepatobiliary Surgery, Enam Medical College and Hospital, Savar, Bangladesh. Fifty patients were identified who underwent surgical evaluation for resectable pancreatic cancer based on preoperative computed tomography examination measuring preoperative tumor markers. Results: Of the 50 patients, 23 (46%) had localized disease and underwent resection, 14 (28%) had locally advanced (unresectable) disease, and 13 (26%) had metastatic disease. Mean adjusted CA19-9 levels were significantly lower in patients with localized disease than in patients with locally advanced (63 vs. 592; P = .003) or metastatic disease (63 vs. 1387; P = .003). When a threshold adjusted CA19-9 level of 150 was used, the positive predictive value for determination of un- resectable disease was 60%. Carcinoembryonic antigen level was not correlated with extent of disease. Conclusion: Among the patients with resectable pancreatic cancer based on preoperative imaging studies, those with abnormally high serum levels of CA19-9 may have unresectable disease. These patients may benefit from additional staging modalities such as diagnostic laparoscopy to avoid unnecessary laparotomy.