The additive value of CA19.9 monitoring in a pancreatic cyst surveillance program.

Autor: Levink IJM; Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Jaarsma SC; Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Koopmann BDM; Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.; Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands., van Riet PA; Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Overbeek KA; Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Meziani J; Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Sprij MLJA; Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Casadei R; Department of Surgery, Bologna University, Bologna, Italy., Ingaldi C; Department of Surgery, Bologna University, Bologna, Italy., Polkowski M; Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland.; Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland., Engels MML; Department of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida, USA.; Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands., van der Waaij LA; Department of Gastroenterology & Hepatology, Martini Hospital, Groningen, The Netherlands., Carrara S; Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy., Pando E; Department of Surgery, Vall d'Hebron Institute of Research, Barcelona, Spain., Vornhülz M; Department of Gastroenterology & Hepatology, Ludwig-Maximilians-University of Munich, Munich, Germany., Honkoop P; Department of Gastroenterology & Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands., Schoon EJ; Department of Gastroenterology & Hepatology, Catharina Hospital, Eindhoven, The Netherlands., Laukkarinen J; Department of Surgery, Tampere University Hospital, Tampere, Finland., Bergmann JF; Department of Gastroenterology & Hepatology, Haga Ziekenhuis, The Hague, The Netherlands., Rossi G; Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy., van Vilsteren FGI; Department of Gastroenterology & Hepatology, University Medical Center Groningen, Groningen, The Netherlands., van Berkel AM; Department of Gastroenterology & Hepatology, Noordwest Hospital, Alkmaar, The Netherlands., Tabone T; Department of Gastroenterology & Hepatology, Mater dei Hospital, Msida, Malta., Schwartz MP; Department of Gastroenterology & Hepatology, Meander Medical Center, Amersfoort, The Netherlands., Tan ACITL; Department of Gastroenterology & Hepatology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands., van Hooft JE; Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Gastroenterology & Hepatology, Amsterdam UMC, Amsterdam, The Netherlands., Quispel R; Department of Gastroenterology & Hepatology, Reinier de Graaf, Delft, The Netherlands., van Soest E; Department of Gastroenterology & Hepatology, Spaarne Gasthuis, Haarlem, The Netherlands., Czacko L; Department of Gastroenterology & Hepatology, University of Szeged, Szeged, Hungary., Bruno MJ; Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands., Cahen DL; Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.; Department of Gastroenterology & Hepatology, Amstelland, Amstelveen, The Netherlands.
Jazyk: angličtina
Zdroj: United European gastroenterology journal [United European Gastroenterol J] 2023 Sep; Vol. 11 (7), pp. 601-611. Date of Electronic Publication: 2023 Jul 12.
DOI: 10.1002/ueg2.12422
Abstrakt: Background: Surveillance of pancreatic cysts focuses on the detection of (mostly morphologic) features warranting surgery. European guidelines consider elevated CA19.9 as a relative indication for surgery. We aimed to evaluate the role of CA19.9 monitoring for early detection and management in a cyst surveillance population.
Methods: The PACYFIC-registry is a prospective collaboration that investigates the yield of pancreatic cyst surveillance performed at the discretion of the treating physician. We included participants for whom at least one serum CA19.9 value was determined by a minimum follow-up of 12 months.
Results: Of 1865 PACYFIC participants, 685 met the inclusion criteria for this study (mean age 67 years, SD 10; 61% female). During a median follow-up of 25 months (IQR 24, 1966 visits), 29 participants developed high-grade dysplasia (HGD) or pancreatic cancer. At baseline, CA19.9 ranged from 1 to 591 kU/L (median 10 kU/L [IQR 14]), and was elevated (≥37 kU/L) in 64 participants (9%). During 191 of 1966 visits (10%), an elevated CA19.9 was detected, and these visits more often led to an intensified follow-up (42%) than those without an elevated CA19.9 (27%; p < 0.001). An elevated CA19.9 was the sole reason for surgery in five participants with benign disease (10%). The baseline CA19.9 value was (as continuous or dichotomous variable at the 37 kU/L threshold) not independently associated with HGD or pancreatic cancer development, whilst a CA19.9 of ≥ 133 kU/L was (HR 3.8, 95% CI 1.1-13, p = 0.03).
Conclusions: In this pancreatic cyst surveillance cohort, CA19.9 monitoring caused substantial harm by shortening surveillance intervals (and performance of unnecessary surgery). The current CA19.9 cutoff was not predictive of HGD and pancreatic cancer, whereas a higher cutoff may decrease false-positive values. The role of CA19.9 monitoring should be critically appraised prior to implementation in surveillance programs and guidelines.
(© 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.)
Databáze: MEDLINE
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