Dynamics of Serum CA19-9 in Patients Undergoing Pancreatic Cancer Resection
Carbohydrate antigen (CA) 19-9 is an established perioperative prognostic biomarker for pancreatic ductal adenocarcinoma (PDAC). However, it is unclear how CA19-9 monitoring should be used during postoperative surveillance to detect recurrence and to guide the initiation of recurrence-focused therap...
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| Veröffentlicht in: | Annals of surgery 2024-03, Vol.279 (3), p.493 |
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| creator | van Oosten, A.F. Groot, V.P. Dorland, G. Burkhart, Richard A. Wolfgang, C.L. van Santvoort, H.C. He, J. Molenaar, I.Q Daamen, L.A. |
| description | Carbohydrate antigen (CA) 19-9 is an established perioperative prognostic biomarker for pancreatic ductal adenocarcinoma (PDAC). However, it is unclear how CA19-9 monitoring should be used during postoperative surveillance to detect recurrence and to guide the initiation of recurrence-focused therapy.
This study aimed to elucidate the value of CA19-9 as a diagnostic biomarker for disease recurrence in patients who underwent PDAC resection.
Serum CA19-9 levels at diagnosis, after surgery, and during postoperative follow-up were analyzed in patients who underwent PDAC resection. All patients with at least two postoperative follow-up CA19-9 measurements before recurrence were included. Patients deemed to be nonsecretors of CA19-9 were excluded. The relative increase in postoperative CA19-9 was calculated for each patient by dividing the maximum postoperative CA19-9 value by the first postoperative value. Receiver operating characteristic analysis was performed to identify the optimal threshold for the relative increase in CA19-9 levels to identify recurrence in the training set using Youden's index. The performance of this cutoff was validated in a test set by calculating the area under the curve (AUC) and was compared to the performance of the optimal cutoff for postoperative CA19-9 measurements as a continuous value. In addition, sensitivity, specificity, and predictive values were assessed.
In total, 271 patients were included, of whom 208 (77%) developed recurrence. Receiver operating characteristic analysis demonstrated that a relative increase in postoperative serum CA19-9 of 2.6× was predictive of recurrence, with 58% sensitivity, 83% specificity, 95% positive predictive value, and 28% negative predictive value. The AUC for a 2.6× relative increase in the CA19-9 level was 0.719 in the training set and 0.663 in the test set. The AUC of postoperative CA19-9 as a continuous value (optimal threshold, 52) was 0.671 in the training set. In the training set, the detection of a 2.6-fold increase in CA19-9 preceded the detection of recurrence by a mean difference of 7 months ( P |
| doi_str_mv | 10.1097/SLA.0000000000005977 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2832574370</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2832574370</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3527-fd23ca23a98409440eb6d81328eda18a5cb475142eeee8088c541a83a3912043</originalsourceid><addsrcrecordid>eNpdkFtPAjEQhRujEUT_gTH76Euxt6XtI8FrJNEIPjelOwure8F2N4R_bw14ifMykzNzvkkOQueUDCnR8mo2HQ_Jn0q1lAeoT1OmMKWCHKJ-VDkWmrMeOgnhjRAqFJHHqMclV1rpUR89Xm9rWxUuJE2ezMB3VTIZU411UtTJs20LqNuQvNYZ-GVT1Muo1c5DXLhkEkfwyQsEcG3R1KfoKLdlgLN9H6D57c18co-nT3cPk_EUO54yifOMcWcZt1oJooUgsBhlinKmILNU2dQthEypYBBLEaVcKqhV3HJNGRF8gC532LVvPjoIramK4KAsbQ1NFwxTnKVScEniqdidOt-E4CE3a19U1m8NJeYrRRNTNP9TjLaL_YduUUH2Y_qO7Ze7acoWfHgvuw14swJbtqsdb5QqrPWeiiM4mj8BDAt6VA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2832574370</pqid></control><display><type>article</type><title>Dynamics of Serum CA19-9 in Patients Undergoing Pancreatic Cancer Resection</title><source>PubMed Central</source><source>Journals@Ovid Complete</source><creator>van Oosten, A.F. ; Groot, V.P. ; Dorland, G. ; Burkhart, Richard A. ; Wolfgang, C.L. ; van Santvoort, H.C. ; He, J. ; Molenaar, I.Q ; Daamen, L.A.</creator><creatorcontrib>van Oosten, A.F. ; Groot, V.P. ; Dorland, G. ; Burkhart, Richard A. ; Wolfgang, C.L. ; van Santvoort, H.C. ; He, J. ; Molenaar, I.Q ; Daamen, L.A.</creatorcontrib><description>Carbohydrate antigen (CA) 19-9 is an established perioperative prognostic biomarker for pancreatic ductal adenocarcinoma (PDAC). However, it is unclear how CA19-9 monitoring should be used during postoperative surveillance to detect recurrence and to guide the initiation of recurrence-focused therapy.
This study aimed to elucidate the value of CA19-9 as a diagnostic biomarker for disease recurrence in patients who underwent PDAC resection.
Serum CA19-9 levels at diagnosis, after surgery, and during postoperative follow-up were analyzed in patients who underwent PDAC resection. All patients with at least two postoperative follow-up CA19-9 measurements before recurrence were included. Patients deemed to be nonsecretors of CA19-9 were excluded. The relative increase in postoperative CA19-9 was calculated for each patient by dividing the maximum postoperative CA19-9 value by the first postoperative value. Receiver operating characteristic analysis was performed to identify the optimal threshold for the relative increase in CA19-9 levels to identify recurrence in the training set using Youden's index. The performance of this cutoff was validated in a test set by calculating the area under the curve (AUC) and was compared to the performance of the optimal cutoff for postoperative CA19-9 measurements as a continuous value. In addition, sensitivity, specificity, and predictive values were assessed.
In total, 271 patients were included, of whom 208 (77%) developed recurrence. Receiver operating characteristic analysis demonstrated that a relative increase in postoperative serum CA19-9 of 2.6× was predictive of recurrence, with 58% sensitivity, 83% specificity, 95% positive predictive value, and 28% negative predictive value. The AUC for a 2.6× relative increase in the CA19-9 level was 0.719 in the training set and 0.663 in the test set. The AUC of postoperative CA19-9 as a continuous value (optimal threshold, 52) was 0.671 in the training set. In the training set, the detection of a 2.6-fold increase in CA19-9 preceded the detection of recurrence by a mean difference of 7 months ( P <0.001) and in the test set by 10 months ( P <0.001).
A relative increase in the postoperative serum CA19-9 level of 2.6-fold is a stronger predictive marker for recurrence than a continuous CA19-9 cutoff. A relative CA19-9 increase can precede the detection of recurrence on imaging for up to 7 to 10 months. Therefore, CA19-9 dynamics can be used as a biomarker to guide the initiation of recurrence-focused treatment.</description><identifier>ISSN: 0003-4932</identifier><identifier>ISSN: 1528-1140</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0000000000005977</identifier><identifier>PMID: 37389896</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><ispartof>Annals of surgery, 2024-03, Vol.279 (3), p.493</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3527-fd23ca23a98409440eb6d81328eda18a5cb475142eeee8088c541a83a3912043</citedby><cites>FETCH-LOGICAL-c3527-fd23ca23a98409440eb6d81328eda18a5cb475142eeee8088c541a83a3912043</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37389896$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van Oosten, A.F.</creatorcontrib><creatorcontrib>Groot, V.P.</creatorcontrib><creatorcontrib>Dorland, G.</creatorcontrib><creatorcontrib>Burkhart, Richard A.</creatorcontrib><creatorcontrib>Wolfgang, C.L.</creatorcontrib><creatorcontrib>van Santvoort, H.C.</creatorcontrib><creatorcontrib>He, J.</creatorcontrib><creatorcontrib>Molenaar, I.Q</creatorcontrib><creatorcontrib>Daamen, L.A.</creatorcontrib><title>Dynamics of Serum CA19-9 in Patients Undergoing Pancreatic Cancer Resection</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>Carbohydrate antigen (CA) 19-9 is an established perioperative prognostic biomarker for pancreatic ductal adenocarcinoma (PDAC). However, it is unclear how CA19-9 monitoring should be used during postoperative surveillance to detect recurrence and to guide the initiation of recurrence-focused therapy.
This study aimed to elucidate the value of CA19-9 as a diagnostic biomarker for disease recurrence in patients who underwent PDAC resection.
Serum CA19-9 levels at diagnosis, after surgery, and during postoperative follow-up were analyzed in patients who underwent PDAC resection. All patients with at least two postoperative follow-up CA19-9 measurements before recurrence were included. Patients deemed to be nonsecretors of CA19-9 were excluded. The relative increase in postoperative CA19-9 was calculated for each patient by dividing the maximum postoperative CA19-9 value by the first postoperative value. Receiver operating characteristic analysis was performed to identify the optimal threshold for the relative increase in CA19-9 levels to identify recurrence in the training set using Youden's index. The performance of this cutoff was validated in a test set by calculating the area under the curve (AUC) and was compared to the performance of the optimal cutoff for postoperative CA19-9 measurements as a continuous value. In addition, sensitivity, specificity, and predictive values were assessed.
In total, 271 patients were included, of whom 208 (77%) developed recurrence. Receiver operating characteristic analysis demonstrated that a relative increase in postoperative serum CA19-9 of 2.6× was predictive of recurrence, with 58% sensitivity, 83% specificity, 95% positive predictive value, and 28% negative predictive value. The AUC for a 2.6× relative increase in the CA19-9 level was 0.719 in the training set and 0.663 in the test set. The AUC of postoperative CA19-9 as a continuous value (optimal threshold, 52) was 0.671 in the training set. In the training set, the detection of a 2.6-fold increase in CA19-9 preceded the detection of recurrence by a mean difference of 7 months ( P <0.001) and in the test set by 10 months ( P <0.001).
A relative increase in the postoperative serum CA19-9 level of 2.6-fold is a stronger predictive marker for recurrence than a continuous CA19-9 cutoff. A relative CA19-9 increase can precede the detection of recurrence on imaging for up to 7 to 10 months. Therefore, CA19-9 dynamics can be used as a biomarker to guide the initiation of recurrence-focused treatment.</description><issn>0003-4932</issn><issn>1528-1140</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNpdkFtPAjEQhRujEUT_gTH76Euxt6XtI8FrJNEIPjelOwure8F2N4R_bw14ifMykzNzvkkOQueUDCnR8mo2HQ_Jn0q1lAeoT1OmMKWCHKJ-VDkWmrMeOgnhjRAqFJHHqMclV1rpUR89Xm9rWxUuJE2ezMB3VTIZU411UtTJs20LqNuQvNYZ-GVT1Muo1c5DXLhkEkfwyQsEcG3R1KfoKLdlgLN9H6D57c18co-nT3cPk_EUO54yifOMcWcZt1oJooUgsBhlinKmILNU2dQthEypYBBLEaVcKqhV3HJNGRF8gC532LVvPjoIramK4KAsbQ1NFwxTnKVScEniqdidOt-E4CE3a19U1m8NJeYrRRNTNP9TjLaL_YduUUH2Y_qO7Ze7acoWfHgvuw14swJbtqsdb5QqrPWeiiM4mj8BDAt6VA</recordid><startdate>20240301</startdate><enddate>20240301</enddate><creator>van Oosten, A.F.</creator><creator>Groot, V.P.</creator><creator>Dorland, G.</creator><creator>Burkhart, Richard A.</creator><creator>Wolfgang, C.L.</creator><creator>van Santvoort, H.C.</creator><creator>He, J.</creator><creator>Molenaar, I.Q</creator><creator>Daamen, L.A.</creator><general>Lippincott Williams & Wilkins</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20240301</creationdate><title>Dynamics of Serum CA19-9 in Patients Undergoing Pancreatic Cancer Resection</title><author>van Oosten, A.F. ; Groot, V.P. ; Dorland, G. ; Burkhart, Richard A. ; Wolfgang, C.L. ; van Santvoort, H.C. ; He, J. ; Molenaar, I.Q ; Daamen, L.A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3527-fd23ca23a98409440eb6d81328eda18a5cb475142eeee8088c541a83a3912043</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Oosten, A.F.</creatorcontrib><creatorcontrib>Groot, V.P.</creatorcontrib><creatorcontrib>Dorland, G.</creatorcontrib><creatorcontrib>Burkhart, Richard A.</creatorcontrib><creatorcontrib>Wolfgang, C.L.</creatorcontrib><creatorcontrib>van Santvoort, H.C.</creatorcontrib><creatorcontrib>He, J.</creatorcontrib><creatorcontrib>Molenaar, I.Q</creatorcontrib><creatorcontrib>Daamen, L.A.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van Oosten, A.F.</au><au>Groot, V.P.</au><au>Dorland, G.</au><au>Burkhart, Richard A.</au><au>Wolfgang, C.L.</au><au>van Santvoort, H.C.</au><au>He, J.</au><au>Molenaar, I.Q</au><au>Daamen, L.A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Dynamics of Serum CA19-9 in Patients Undergoing Pancreatic Cancer Resection</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2024-03-01</date><risdate>2024</risdate><volume>279</volume><issue>3</issue><spage>493</spage><pages>493-</pages><issn>0003-4932</issn><issn>1528-1140</issn><eissn>1528-1140</eissn><abstract>Carbohydrate antigen (CA) 19-9 is an established perioperative prognostic biomarker for pancreatic ductal adenocarcinoma (PDAC). However, it is unclear how CA19-9 monitoring should be used during postoperative surveillance to detect recurrence and to guide the initiation of recurrence-focused therapy.
This study aimed to elucidate the value of CA19-9 as a diagnostic biomarker for disease recurrence in patients who underwent PDAC resection.
Serum CA19-9 levels at diagnosis, after surgery, and during postoperative follow-up were analyzed in patients who underwent PDAC resection. All patients with at least two postoperative follow-up CA19-9 measurements before recurrence were included. Patients deemed to be nonsecretors of CA19-9 were excluded. The relative increase in postoperative CA19-9 was calculated for each patient by dividing the maximum postoperative CA19-9 value by the first postoperative value. Receiver operating characteristic analysis was performed to identify the optimal threshold for the relative increase in CA19-9 levels to identify recurrence in the training set using Youden's index. The performance of this cutoff was validated in a test set by calculating the area under the curve (AUC) and was compared to the performance of the optimal cutoff for postoperative CA19-9 measurements as a continuous value. In addition, sensitivity, specificity, and predictive values were assessed.
In total, 271 patients were included, of whom 208 (77%) developed recurrence. Receiver operating characteristic analysis demonstrated that a relative increase in postoperative serum CA19-9 of 2.6× was predictive of recurrence, with 58% sensitivity, 83% specificity, 95% positive predictive value, and 28% negative predictive value. The AUC for a 2.6× relative increase in the CA19-9 level was 0.719 in the training set and 0.663 in the test set. The AUC of postoperative CA19-9 as a continuous value (optimal threshold, 52) was 0.671 in the training set. In the training set, the detection of a 2.6-fold increase in CA19-9 preceded the detection of recurrence by a mean difference of 7 months ( P <0.001) and in the test set by 10 months ( P <0.001).
A relative increase in the postoperative serum CA19-9 level of 2.6-fold is a stronger predictive marker for recurrence than a continuous CA19-9 cutoff. A relative CA19-9 increase can precede the detection of recurrence on imaging for up to 7 to 10 months. Therefore, CA19-9 dynamics can be used as a biomarker to guide the initiation of recurrence-focused treatment.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>37389896</pmid><doi>10.1097/SLA.0000000000005977</doi></addata></record> |
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| title | Dynamics of Serum CA19-9 in Patients Undergoing Pancreatic Cancer Resection |
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