Postoperative serum CEA and CA125 levels are supplementary to perioperative CA19–9 levels in predicting operative outcomes of pancreatic ductal adenocarcinoma

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Carbohydrate antigen (CA19–9) is a well-established marker to monitor disease status after resection of pancreatic cancer. However, few serum markers have been reported to improve the prognostic ability of postoperative CA19–9, especially in patients with normal postoperative CA19–9.


A total of 353 patients with pancreatic ductal adenocarcinoma treated by radical resection were reviewed retrospectively, and a prospective cohort including 142 patients with resectable pancreatic head carcinoma was analyzed as a validation cohort. Perioperative CA19–9 and postoperative serum markers (CEA, CA242, CA72–4, CA50, CA125, CA153, and AFP) were investigated.


Patients with postoperative normalization of CA19–9 had improved survival times (recurrence-free survival: 11.9 months; overall survival: 22.5 months) compared with those with decreased but still elevated postoperative CA19–9 (recurrence-free survival: 6.8 months, P < .001; overall survival: 13.5 months, P < .001) or those with increased postoperative CA19–9 (recurrence-free survival: 3.5 months, P < .001; overall survival: 7.9 months, P < .001), which was similar to those with consistently normal CA19–9 during perioperative periods (recurrence-free survival: 10.6 months, P = .799; overall survival: 24.1 months, P = .756). Normal postoperative CA19–9 levels were an independent indicator for a positive outcome after operation, regardless of preoperative CA19–9 levels. Elevated postoperative CEA and CA125 were identified further as independent risk factors for patients with normal postoperative CA19–9, while elevated postoperative CA125 and nondecreased postoperative CA19–9 were independent prognostic markers for patients with elevated postoperative CA19–9.


The postoperative monitoring of CEA and CA125 provided prognostic significance to the measurement of CA19–9 in pancreatic cancer after resection.

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