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In Reply

Massachusetts General Hospital, Boston, MA

Andrew L. Warshaw

Massachusetts General Hospital, Boston, MA

We agree with Dr Halm that an isolated measurement of CA19-9 concentration has limited value in the treatment decision of individual patients, and that there is a very broad range in the concentrations of this serum marker. It is because of the skewed distribution of the CA19-9 values that median, rather than mean, is routinely utilized in studies involving this marker. We in fact do state the range and quartiles of the values in the results section, and levels of nearly 19,000 were found in one of our patients. In addition to confirming previous studies that have correlated CA19-9 concentrations with tumor stage and survival, our study¹ shows by multivariate Cox model that a decrease in CA19-9 after resection, and an absolute value of less than 200 U/mL, are both independent prognostic factors predicting increased survival. The power of these two variables was as strong as T stage and absence of lymph node metastases. It is for this reason that we propose that postoperative CA19-9 values may be useful to stratify pancreatic cancer patients for adjuvant trials.

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

REFERENCE

1. Ferrone CR, Finkelstein DM, Thayer SP, et al: Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma. J Clin Oncol 24:2897-2902, 2006[Abstract/Free Full Text]

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