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

Iris J.M. Levink*, Sanne C. Jaarsma, the PACYFIC-registry work group, Brechtje D.M. Koopmann, Priscilla A. van Riet, Kasper A. Overbeek, Jihane Meziani, Marloes L.J.A. Sprij, Riccardo Casadei, Carlo Ingaldi, Marcin Polkowski, Megan M.L. Engels, Laurens A. van der Waaij, Silvia Carrara, Elizabeth Pando, Marlies Vornhülz, Pieter Honkoop, Erik J. Schoon, Johanna Laukkarinen, Jilling F. BergmannGemma Rossi, Frederike G.I. van Vilsteren, Anne Marie van Berkel, Trevor Tabone, Matthijs P. Schwartz, Adriaan C.I.T.L. Tan, Jeanin E. van Hooft, Rutger Quispel, Ellert van Soest, Laszlo Czacko, Marco J. Bruno, Djuna L. Cahen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
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Abstract

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.

Original languageEnglish
Pages (from-to)601-611
Number of pages11
JournalUnited European Gastroenterology Journal
Volume11
Issue number7
Early online date12 Jul 2023
DOIs
Publication statusPublished - Sept 2023

Bibliographical note

Funding Information:
We would like to acknowledge all fellows that worked hard to make this database work: Ora Illes (University of Szeged), Neville Azzopardi (Mater Dei Hospital), Reea Ahola (Tampere University Hospital), Georg Beyer (LMU Hospital Munich), Julia Mayerle (LMU Hospital Munich), Rafal Lipczynski (MSC National Research Institute of Oncology Warsaw), Sanne Hoogendoorn (Amsterdam UMC), Nadine van Huijgevoort (Amsterdam UMC), Derk Klatte (Mayo Clinic Florida), Elena Finati (Humanitas Research Hospital) and Leah T'ien (St Paul's Hospital). They do not fulfill the requirements for authorship, yet substantially attributed to the project.

Publisher Copyright:
© 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.

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