Diagnositic and Prognoistic values of serum CEA and CA19-9 levels in Periampullary Cancer

Kim, Hae Jeong; Park, Youn Chan; Ahn, Yong Joon; Jang, Jin Young; Kim, Sun Whe; Lee, Kuhn Uk; Park, Yong Hyun

Abstract

PURPOSE: The value of carcinoembryonic antigen(CEA) and carbohydrate antigen 19-9(CA19-9) in periampullary cancers have not been clearly established. Diagnostic and prognostic values of these two markers in resectable periampullary cancer were clarified in this study.
METHODS
Preoperative serum levels of CEA and CA19-9, and clinicopathologic features were reviewed in 151 surgical patients with periampullary cancer who were admitted in department of General Surgery of Seoul National University Hospital from Feb. 1996 to Dec. 2000. Postoperative serum levels of these tumor markers were also reviewed. For comparison with benign disease, preoperative serum levels of these tumor markers in GB stone patients were reviewed. After resection, serial tumor markers had been followed up. Disease recurrence was confirmed by imaging study.
RESULTS
The CA19-9 concentration was above the cut-off limit (37U/ml) in 60.8% and the CEA concentration was above the cut-off limit(5ng/ml) in 10.5% of the periampullary cancer. Preoperative serum CEA and CA19-9 did not demonstrate the TMN stage, pathologic differentiation and the tumor size. The difference between the survival curves of the preoperative serum CA19-9 level (cut-off 100U/ml) was highly significant (p<0.05) in ampullary cancer. After curative resection, the serum CEA and CA19-9 level were decreased below cut-off level (5ng/mg in CEA, 37U/ml in CA19-9) in 55.6% and 71.2% of total periampullary cancer patients respectively. The mean survival period of the group with normalized CA19-9 level after surgery was significantly longer than that of the group with persistent elevated serum CA19-9 level (52.18 vs 21month, p<0.005) in ampullary cancer. The recurrent sensitivities of the CA19-9 were 57%, 50%, 67% in ampullary cancer cancer, distal CBD cancer, pancreatic head cancer respectively.
CONCLUSION
Serial check of serum levels of the CA19-9, CEA is useful in diagnosis and recurrence detection in periampullary cancer.