TY - JOUR
T1 - The additive value of CA19.9 monitoring in a pancreatic cyst surveillance program
AU - Levink, Iris J.M.
AU - Jaarsma, Sanne C.
AU - Koopmann, Brechtje D.M.
AU - van Riet, Priscilla A.
AU - Overbeek, Kasper A.
AU - Meziani, Jihane
AU - Sprij, Marloes L.J.A.
AU - Casadei, Riccardo
AU - Ingaldi, Carlo
AU - Polkowski, Marcin
AU - Engels, Megan M.L.
AU - van der Waaij, Laurens A.
AU - Carrara, Silvia
AU - Pando, Elizabeth
AU - Vornhülz, Marlies
AU - Honkoop, Pieter
AU - Schoon, Erik J.
AU - Laukkarinen, Johanna
AU - Bergmann, Jilling F.
AU - Rossi, Gemma
AU - van Vilsteren, Frederike G.I.
AU - van Berkel, Anne Marie
AU - Tabone, Trevor
AU - Schwartz, Matthijs P.
AU - Tan, Adriaan C.I.T.L.
AU - van Hooft, Jeanin E.
AU - Quispel, Rutger
AU - van Soest, Ellert
AU - Czacko, Laszlo
AU - Bruno, Marco J.
AU - Cahen, Djuna L.
N1 - Publisher Copyright:
© 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.
PY - 2023/9
Y1 - 2023/9
N2 - 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.
AB - 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.
KW - biomarkers
KW - CA19.9
KW - early detection
KW - follow-up
KW - GICA
KW - pancreatic cancer
KW - pancreatic cysts
KW - pancreatic lesions
KW - surgical intervention
KW - surveillance
UR - http://www.scopus.com/inward/record.url?scp=85164906461&partnerID=8YFLogxK
U2 - 10.1002/ueg2.12422
DO - 10.1002/ueg2.12422
M3 - Article
C2 - 37435855
AN - SCOPUS:85164906461
SN - 2050-6406
VL - 11
SP - 601
EP - 611
JO - United European Gastroenterology Journal
JF - United European Gastroenterology Journal
IS - 7
ER -