Relationship Between Serum CA 19-9 Levels and Lymphovascular and Perineural Invasion of the Tumor and Lymph Node Metastasis in Patients Operated due to Pancreatic Carcinoma

Year 2022, Volume: 75 Issue: 1, 113 - 118, 30.06.2022

Meriç Emre Bostancı

Abstract

Objectives: The aim of this study was to determine the relationship between serum CA 19-9 levels and lymphovascular and perineural invasion and lymph node metastasis in patients operated due to pancreatic cancer.

Materials and Methods: A total of 32 patients underwent pancreaticoduodenectomy or distal pancreatectomy at Sivas Cumhuriyet University Department of Surgical Oncology. CA 19-9 values were evaluated by retrospectively examining the data of the patients. By examining the pathology reports, the presence of lymphovascular and perineural invasion and lymph node metastasis was evaluated.

Results: The mean serum CA 19-9 level in patients with lymphovascular invasion was 242.38 U/mL, and the mean serum CA 19-9 level in patients without lymphovascular invasion was 31.73 U/mL. The mean serum CA 19-9 level was 220.93 U/mL in patients with perineural invasion and 15.23 U/mL in patients without perineural invasion. The mean serum CA 19-9 level was 238.52 U/mL in patients with lymph node metastasis and 35.16 U/ mL in patients without lymph node metastasis. A value of 16.25 U/mL of serum CA 19-9 gives a positive result of 84.7% for lymphovascular invasion and 91.8% for perineural invasion. A value of 27.06 U/mL of serum CA 19-9 gives a positive result of 85.9% for lymph node metastasis.

Conclusion: Lymphovascular invasion was detected in 94.44% and perineural invasion was detected in 90.48% of our patients with serum CA19- 9 values above 16.25 U/mL. Lymph node metastasis was detected in 80.7% of our patients with serum CA19-9 values above 27.06 U/mL. Before surgery, it is important to predict the probability of lymphovascular and perineural invasion of the tumor and lymph node metastasis, and to make the decision to perform broader surgery and perform adjuvant, neoadjuvant therapy and serum CA19-9 levels are of great benefit in this regard

Keywords

: Pancreatic Cancer , CA 19-9 , Lymphovascular And Perineural Invasion

Ethical Statement

Ethics Committee Approval: Ethics committee approval of the study was obtained from Sivas Cumhuriyet University Clinical Research Ethics Committee with the decision numbered 2020-10/34. Informed Consent: We have received verbal consent from patients. Peer-review: Externally peer-reviewed. Authorship Contributions Surgical and Medical Practices: M.E.B., M.C.M., K.K., Concept: M.E.B., M.C.M., K.K., Design: M.E.B., M.C.M., K.K., Data Collection or Processing: M.E.B., M.C.M., K.K., Analysis or Interpretation: M.E.B., M.C.M., K.K., Literature Search: M.E.B., M.C.M., K.K., Writing: M.E.B., M.C.M., K.K. Conflict of Interest: We declare that there is no conflicts of interest associated with this publication. Financial Disclosure: We declare that we have not received any financial support to perform this study

Supporting Institution

-

Project Number

-

Thanks

-

References

• 1. American Cancer Society. Cancer facts & figures 2014. Atlanta, Georgia: American Cancer Society; 2014. acspc-042151.pdf. Accessed March 28 2014.
• 2. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225-249.
• 3. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277-300.
• 4. Howlader N, Noone AM, Krapcho M, et al. Cancer Statistics Review, 1975- 2012 - SEER Statistics. National Cancer Institute. Bethesda, MD. https://seer. cancer.gov/archive/csr/1975_2012/
• 5. Muniraj T, Jamidar PA, Aslanian HR. Pancreatic cancer: a comprehensive review and update. Dis Mon. 2013;59:368-402.
• 6. Boone BA, Steve J, Zenati MS, et al. Serum CA 19-9 response to neoadjuvant therapy is associated with outcome in pancreatic adenocarcinoma. Ann Surg Oncol. 2014;21:4351-4358.
• 7. Ito S, Gejyo F. Elevation of serum CA19-9 levels in benign diseases. Intern Med. 1999;38:840-841.
• 8. Fujioka S, Misawa T, Okamoto T, et al. Preoperative serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels for the evaluation of curability and resectability in patients with pancreatic adenocarcinoma. J Hepatobiliary Pancreat Surg. 2007;14:539-544.
• 9. Meyer W, Jurowich C, Reichel M, et al. Pathomorphological and histological prognostic factors in curatively resected ductal adenocarcinoma of the pancreas. Surg Today. 2000;30:582-587.
• 10. Kayahara M, Nagakawa T, Ohta T, et al. Surgical strategy for carcinoma of the papilla of Vater on the basis of lymphatic spread and mode of recurrence. Surgery. 1997;121:611-617.
• 11. Moriya T, Kimura W, Hirai I, et al. Nodal involvement as an indicator of postoperative liver metastasis in carcinoma of the papilla of Vater. J Hepatobiliary Pancreat Surg. 2006;13:549-555.
• 12. Gebhardt C, Meyer W, Reichel M, et al. Prognostic factors in the operative treatment of ductal pancreatic carcinoma. Langenbecks Arch Surg. 2000;385:14-20.
• 13. Sierzega M, Popiela T, Kulig J, et al. The ratio of metastatic/resected lymph nodes is an independent prognostic factor in patients with node-positive pancreatic head cancer. Pancreas. 2006;33:240-245.
• 14. Slidell MB, Chang DC, Cameron JL, et al. Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis. Ann Surg Oncol. 2008;15:165-174.
• 15. Liu B, Lu KY. Neural invasion in pancreatic carcinoma. Hepatobiliary Pancreat Dis Int. 2002;1:469-476.
• 16. Kayahara M, Nakagawara H, Kitagawa H, et al. The nature of neural invasion by pancreatic cancer. Pancreas. 2007;35:218-223.
• 17. Anderson KE, Mack T, Silverman D. Cancer of the pancreas. In: Schottenfeld D, Fraumeni JF ed. Cancer epidemiology and prevention. New York: Oxford University; 2006. s. 721-762.
• 18. Samra JS, Gananadha S, Hugh TJ. Surgical management of carcinoma of the head of pancreas: extended lymphadenectomy or modified en bloc resection? ANZ J Surg. 2008;78:228-236.
• 19. Ihse I, Andersson R, Ask A, et al. Intraoperative radiotherapy for patients with carcinoma of the pancreas. Pancreatology. 2005;5:438-442.
• 20. Kloppel G, Klimstra D. Tumors of the exocrine pancreas. In: Fletcher CDM ed. Diagnostic histopathology of tumors. Churchill Livingstone Elsevier; 2007. s. 463-484
• 21. Safalı M. Pankreas patolojisi. Mocan Kuzey G ed. Temel Patoloji, Ankara: Güneş Kitabevi; 2007. s. 517-524.
• 22. Goonetilleke KS, Siriwardena AK. Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer. Eur J Surg Oncol. 2007;33:266-270.
• 23. Ben QW, Wang JC, Liu J, et al. Positive expression of L1-CAM is associated with perineural invasion and poor outcome in pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2010;17:2213-2221.
• 24. Pour PM, Egami H, Takiyama Y. Patterns of growth and metastases of induced pancreatic cancer in relation to the prognosis and its clinical implications. Gastroenterology. 1991;100:529-536.
• 25. Liu B, Lu KY. Neural invasion in pancreatic carcinoma. Hepatobiliary Pancreat Dis Int. 2002;1:469-476.
• 26. Schlieman MG, Ho HS, Bold RJ. Utility of tumor markers in determining resectability of pancreatic cancer. Arch Surg. 2003;138:951-5; discussion 955-956.
• 27. Katz A, Hanlon A, Lanciano R, et al. Prognostic value of CA 19-9 levels in patients with carcinoma of the pancreas treated with radiotherapy. Int J Radiat Oncol Biol Phys. 1998;41:393-396.
• 28. Sohn TA, Yeo CJ, Cameron JL, et al. Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg. 2000;4:567-579.
• 29. Sierzega M, Popiela T, Kulig J, et al. The ratio of metastatic/resected lymph nodes is an independent prognostic factor in patients with node-positive pancreatic head cancer. Pancreas. 2006;33:240-245