Sustained elevation of serum tumor markers after resection is an important prognostic factor for pancreatic cancer

Purpose: Curative resection is the only chance for long-term survival for pancreatic carcinoma, however, the surgical results remain poor. Even after resection with a microscopically negative margin (R0), prognostic factors and predictors of recurrence are needed. Several reports revealed that sustained elevation of tumor markers (TM) after surgery is related to poor prognosis. A questionnaire survey to evaluate perioperative TM status as a prognostic factor for resected pancreatic carcinoma was conducted among Miyagi-HBPCOG institutions in the period from 2003 to 2007. Method: Of 333 cases collected, clinicopathological data including age, gender, operative procedure, TM, and adjuvant therapy from histologically confirmed 294 cohorts in which both pre- and post- operative TM measurements were analyzed by stratification of 3 groups depending on TM status (without increase, with normalization after surgery, with sustained elevation). Results: About 80% of all cohorts had elevated TM and half of them had sustained elevation of postoperative TM. Median survival of the group without elevation of preoperative TM, the group with normalization of postoperative TM, and the group with sustained elevation of postoperative TM were 36.4 months, 24.5 months, and 16.8 months, respectively (P<0.0001). Stage and sustained elevation of postoperative TM had a significant impact on overall survival. By subgroup analyses in the cases with R0 resection, patients with sustained elevation of postoperative TM had significantly poorer survival than those with normalized TM or without elevation of TM. Conclusion: These data showed that sustained elevation of serum tumor markers after resection is an important prognostic factor for pancreatic cancer.