Carbohydrate antigen 19-9 change during chemotherapy for advanced pancreatic adenocarcinoma

Michele Reni, Stefano Cereda, Gianpaolo Balzano, Paolo Passoni, Alessia Rognone, Clara Fugazza, Elena Mazza, Alessandro Zerbi, Valerio Di Carlo, Eugenio Villa

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Radiologic assessment of tumor response in pancreatic cancer is complicated by desmoplastic reactions within or around the tumor. The objective of this study was to evaluate the correlation between a decline in carbohydrate antigen 19-9 (CA 19-9) and survival in patients with advanced pancreatic cancer who received upfront chemotherapy. METHODS: CA 19-9 serum basal values were measured in 247 patients with advanced pancreatic cancer who were enrolled in 5 consecutive trials between 1997 and 2007. Survival curves were compared among patients who had a predefined CA 19-9 nadir variation (89%, Group 3). To eliminate guarantee-time bias, survival analysis was repeated using the landmark method. RESULTS: In both univariate and multivariate analysis, the basal CA 19-9 value significantly predicted survival. The median survival was 15.5 months for 34 patients who had normal basal CA 19-9 values, 11.9 months for 108 patients who had basal values between 38 U/mL and 1167 U/mL, and 8 months for 105 patients who had basal values >1167 U/mL. At least 1 CA 19-9 follow-up value was available for 204 patients who had baseline values greater than normal. A significant difference in overall survival was observed in univariate and multivariate analyses between Groups 1 and 2, between Groups 1 and 3, and between Groups 2 and 3. The results were confirmed using the landmark method. CONCLUSIONS: In this study, baseline CA 19-9 was confirmed as an independent prognostic factor for survival, and it may be considered as a stratification factor in trials in patients with advanced pancreatic cancer. Biochemical response may be used as a complementary measure to radiologic response to provide a better assessment of chemotherapy activity and to drive treatment decisions in clinical practice.

Original languageEnglish
Pages (from-to)2630-2639
Number of pages10
Issue number12
Publication statusPublished - Jun 15 2009


  • Carbohydrate antigen 19-9
  • Chemotherapy
  • Pancreatic cancer
  • Prognostic factors

ASJC Scopus subject areas

  • Cancer Research
  • Oncology


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