The American Journal of Surgery
Volume 198, Issue 3 , Pages 333-339 , September 2009

CA19-9 serum levels in obstructive jaundice: clinical value in benign and malignant conditions

  • Daniele Marrelli, M.D.

      Affiliations

    • Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Viale Bracci-Policlinico “Le Scotte” 53100, Siena, Italy
    • Corresponding Author InformationCorresponding author. Tel.: +0039 0577 585882; fax: +0039 0577 585882
    • ,
  • Stefano Caruso, M.D.

      Affiliations

    • Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Viale Bracci-Policlinico “Le Scotte” 53100, Siena, Italy
    • ,
  • Corrado Pedrazzani, M.D.

      Affiliations

    • Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Viale Bracci-Policlinico “Le Scotte” 53100, Siena, Italy
    • ,
  • Alessandro Neri, M.D.

      Affiliations

    • Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Viale Bracci-Policlinico “Le Scotte” 53100, Siena, Italy
    • ,
  • Eduardo Fernandes, M.D., M.R.C.S.

      Affiliations

    • Renal Department, Transplant Unit, Hammersmith Hospital, Imperial College Healthcare Trust, London, UK
    • ,
  • Mario Marini, M.D.

      Affiliations

    • Unit of Gastroenterology, Digestive Endoscopy, University of Siena, Siena, Italy
    • ,
  • Enrico Pinto, M.D.

      Affiliations

    • Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Viale Bracci-Policlinico “Le Scotte” 53100, Siena, Italy
    • ,
  • Franco Roviello, M.D.

      Affiliations

    • Department of Human Pathology and Oncology, Unit of Surgical Oncology, University of Siena, Viale Bracci-Policlinico “Le Scotte” 53100, Siena, Italy

Received 3 October 2008 ,Revised 28 November 2008

References 

  1. Koprowski H, Steplewski Z, Mitchell K, et al. Colorectal carcinoma antigens detected by hybridoma antibodies. Somat Cell Genet. 1979;5:957–971
  2. Steinberg W. The clinical utility of the CA19-9 tumor-associated antigen. Am J Gastroenterol. 1990;85:350–355
  3. Marrelli D, Roviello F, De Stefano A, et al. Prognostic significance of CEA, CA19-9 and CA 72–4 preoperative serum levels in gastric carcinoma. Oncology. 1999;57:55–62
  4. Marrelli D, Pinto E, De Stefano A, et al. Clinical utility of CEA, CA19-9, and CA 72–4 in the follow-up of patients with resectable gastric cancer. Am J Surg. 2001;181:16–19
  5. Patel AH, Harnois DM, Klee GG, et al. The utility of CA 19–9 in the diagnoses of cholangiocarcinoma in patients without primary sclerosing cholangitis. Am J Gastroenterol. 2000;95:204–207
  6. 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. 2006;24:2897–2902
  7. Halloran CM, Ghaneh P, Connor S, et al. Carbohydrate antigen 19.9 accurately selects patients for laparoscopic assessment to determine resectability of pancreatic malignancy. Br J Surg. 2008;95:453–459
  8. Kim HJ, Kim MH, Myung SJ, et al. A new strategy for the application of CA19-9 in the differentiation of pancreaticobiliary cancer: analysis using a receiver operating characteristic curve. Am J Gastroenterol. 1999;94:1941–1946
  9. 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
  10. Ong SL, Sachdeva A, Garcea G, et al. Elevation of carbohydrate antigen 19.9 in benign hepatobiliary conditions and its correlation with serum bilirubin concentration. Digest Dis Sci. 2008;53:3213–3217
  11. Paganuzzi M, Onetto M, Marroni P, et al. Ca 19–9 and Ca 50 in benign and malignant pancreatic and biliary diseases. Cancer. 1988;61:2100–2108
  12. Mann DV, Edwards R, Ho S, et al. Elevated tumour marker CA19-9: clinical interpretation and influence of obstructive jaundice. Eur J Surg Oncol. 2000;26:474–479
  13. Cassidy LD. Basic concepts of statistical analysis for surgical research. J Surg Res. 2005;128:199–206
  14. Haglund C, Roberts PJ, Kuusela P, et al. Evaluation of CA 19–9 as a serum tumour marker in pancreatic cancer. Br J Cancer. 1986;53:197–202
  15. Albert MB, Steinberg WM, Henry JP. Elevated serum levels of tumor marker CA19-9 in acute cholangitis. Digest Dis Sci. 1988;33:1223–1225
  16. Yoshida EM, Scudamore CH, Erb SR, et al. Markedly elevated serum CA 19–9 levels in a case of chronic pancreatitis. Can J Surg. 1995;38:83–86
  17. Maestranzi S, Przemioslo R, Mitchell H, et al. The effect of benign and malignant liver disease on the tumour markers CA19-9 and CEA. Ann Clin Biochem. 1998;35:99–103
  18. Duffy MJ. 19–9 As a marker for gastrointestinal cancers: a review. Ann Clin Biochem. 1998;35:364–370
  19. Kodama T, Satoh H, Ishikawa H, et al. Serum levels of CA19-9 in patients with nonmalignant respiratory diseases. J Clin Lab Anal. 2007;21:103–106
  20. Ker CG, Chen JS, Lee KT, et al. Assessment of serum and bile levels of CA19-9 and CA125 in cholangitis and bile duct carcinoma. J Gastroenterol Hepatol. 1991;6:505–508
  21. Basso D, Meggiato T, Fabris C, et al. Extra-hepatic cholestasis determines a reversible increase of glycoproteic tumour markers in benign and malignant diseases. Eur J Clin Invest. 1992;22:800–804
  22. Dorizzi RM, Di LA, Guglielmi A, et al. Measurement of serum ca 19–9 in biliary diseases requires great caution. Acta Oncol. 2001;40:877–878
  23. Katsanos KH, Kitsanou M, Christodoulou DK, et al. Ca 19–9 levels in benign biliary tract diseases (Report of four cases and review of the literature). Eur J Intern Med. 2002;13:132–135
  24. Sheen-Chen SM, Sun CK, Liu YW, et al. Extremely elevated CA19-9 in acute cholangitis. Digest Dis Sci. 2007;52:3140–3142
  25. Duraker N, Hot S, Polat Y, et al. CEA, CA 19–9, and CA 125 in the differential diagnosis of benign and malignant pancreatic diseases with or without jaundice. J Surg Oncol. 2007;95:142–147
  26. Kang CM, Kim JY, Choi GH, et al. The use of adjusted preoperative CA 19–9 to predict the recurrence of resectable pancreatic cancer. J Surg Res. 2007;140:31–35
  27. Vestergaard EM, Hein HO, Meyer H, et al. Reference values and biological variation for tumor marker ca 19–9 in serum for different Lewis and secretor genotypes and evaluation of secretor and Lewis genotyping in a Caucasian population. Clin Chem. 1999;45:54–61
  28. Koroglu M, Koroglu BK, Akhan O, et al. Effect of percutaneous biliary drainage on serum levels of tumor markers in patients with obstructive jaundice. Hepatogastroenterology. 2006;53:491–496
  29. Barone D, Onetto M, Conio M, et al. CA 19-9 assay in patients with extrahepatic cholestatic jaundice. Int J Biol Markers. 1988;3:95–100
  30. Murray MD, Burton FR, Di Bisceglie AM. Markedly elevated serum CA19–9 levels in association with a benign biliary stricture due to primary sclerosing cholangitis. J Clin Gastroenterol. 2007;41:115–117
  31. Madonia S, Aragona E, Maisano S, et al. Ca 19–9 to rule out pancreatic or biliary cancer among patients with cholestasis: an unsuitable test?. Digest Dis Sci. 2007;52:1125–1127
  32. Weston BR, Ross WA, Wolff RA, et al. Rate of bilirubin regression after stenting in malignant biliary obstruction for the initiation of chemotherapy: how soon should we repeat endoscopic retrograde cholangiopancreatography?. Cancer. 2008;112:2417–2423
  33. Mortenson MM, Katz MH, Tamm EP, et al. Current diagnosis and management of unusual pancreatic tumors. Am J Surg. 2008;196:100–113

 This study was supported by grant PAR, University of Siena, Italy.

PII: S0002-9610(09)00127-5

doi: 10.1016/j.amjsurg.2008.12.031

The American Journal of Surgery
Volume 198, Issue 3 , Pages 333-339 , September 2009

Article Tools

* Image Usage & Resolution