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Schiergens, Tobias S.; Renz, Bernhard W.; Reu, Simone; Neumann, Jens; Al-Sayegh, Rami; Niess, Hanno; Ilmer, Matthias; Kruger, Stephan; Böck, Stefan; Heinemann, Volker; Werner, Jens; Kleespies, Axel (2017): Prognostic Value of Preoperative Serum Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 After Resection of Ampullary Cancer. In: Journal of Gastrointestinal Surgery, Vol. 21, No. 11: pp. 1775-1783
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Background The purpose of this study is to investigate the prognostic value of pre-resection serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 after resection of ampullary cancer (AC) in consideration of intestinal (IT) and pancreatobiliary (PT) subtypes. Methods Overall survival (OS) analysis of patients undergoing curative resection of ampullary cancer. Results Elevated preoperative CEA (P = 0.013) and CA 19-9 levels (P = 0.030) were significant prognostic factors. Subgroup analysis, however, showed both markers having prognostic value only for the IT subgroup. Pre-resection CEA within normal range identified a subgroup of IT patients with an excellent median survival of 145 months. Compared to other AC patients, this low-risk ITCEA- subpopulation was characterized by less frequent advanced pT stages (pT3/pT4, 41 vs. 62%;P = 0.047) and lymph node involvement (pN+, 30 vs. 65%;P = 0.001). OS of this subgroup was significantly better compared to other AC patients (145 vs. 25 months;HR = 3.8;P < 0.001). By multivariate survival analysis, the patient age, the PT subtype, and an elevated pre-resection serum CEA value were identified as independent prognostic variables. Conclusions In AC, the histomorphologic subclassification is highly relevant regarding the prognostic value of preoperative serum CEA and CA 19-9. IT-patients with normal preoperative CEA represent a favorable subgroup with excellent long-term survival.