Medline ® Abstract for Reference 19
of 'Ampullary carcinoma: Epidemiology, clinical manifestations, diagnosis and staging'
Prognosis of resected ampullary adenocarcinoma by preoperative serum CA19-9 levels and platelet-lymphocyte ratio.
Smith RA, Ghaneh P, Sutton R, Raraty M, Campbell F, Neoptolemos JP
J Gastrointest Surg. 2008;12(8):1422. Epub 2008 Jun 10.
BACKGROUND: The objective of this study was to evaluate whether preoperative CA19-9 levels and the platelet-lymphocyte ratio (PLR) might reflect prognostic indices for resected ampullary adenocarcinoma.
MATERIALS AND METHODS: Data were collected prospectively over a 10-year period for consecutive patients undergoing pancreatoduodenectomy for malignancy.
RESULTS: Both preoperative PLR and CA19-9 results were available in 52 cases of resected ampullary adenocarcinoma. Preoperative CA19-9 levels of</=150 kU/l (or</=300 kU/l in the presence of bilirubin levels>35 micromol/l) and a PLR of</=160 were found to represent the optimal cut-off values to risk stratify patients. If both levels were elevated (n = 8), patients had a median overall survival of 10.1 months. If either CA19-9 or PLR were elevated individually (n = 23), patients had a median survival of 25.2 months. For cases where both levels were less than the cut-off values (n = 21), the median overall survival time was not reached but was greater than 60 months (log rank, p<0.001). This preoperative risk stratification was found to remain a significant independent predictor of survival on multivariate analysis (Cox, p = 0.001) alongside resection margin status (p = 0.002) and tumor size (p = 0.051).
CONCLUSIONS: Preoperative CA19-9 and PLR both merit further evaluation as prognostic indices in resected ampullary adenocarcinoma.
Division of Surgery and Oncology, School of Cancer Studies, Royal Liverpool University Hospital, 5th Floor UCD Building, Daulby St., Liverpool, L69 3GA, UK.