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Tsai, Susan; George, Ben; Wittmann, David; Ritch, Paul S.; Krepline, Ashley N.; Aldakkak, Mohammed; Barnes, Chad A.; Christians, Kathleen K.; Dua, Kulwinder; Griffin, Michael; Hagen, Catherine; Hall, William A.; Erickson, Beth A.; Evans, Douglas B.

Importance of Normalization of CA19-9 Levels Following Neoadjuvant Therapy in Patients With Localized Pancreatic Cancer

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  • Media type: E-Article
  • Title: Importance of Normalization of CA19-9 Levels Following Neoadjuvant Therapy in Patients With Localized Pancreatic Cancer
  • Contributor: Tsai, Susan; George, Ben; Wittmann, David; Ritch, Paul S.; Krepline, Ashley N.; Aldakkak, Mohammed; Barnes, Chad A.; Christians, Kathleen K.; Dua, Kulwinder; Griffin, Michael; Hagen, Catherine; Hall, William A.; Erickson, Beth A.; Evans, Douglas B.
  • imprint: Ovid Technologies (Wolters Kluwer Health), 2020
  • Published in: Annals of Surgery
  • Language: English
  • DOI: 10.1097/sla.0000000000003049
  • ISSN: 0003-4932; 1528-1140
  • Keywords: Surgery
  • Origination:
  • Footnote:
  • Description: <jats:sec> <jats:title>Objective:</jats:title> <jats:p>Carbohydrate antigen 19-9 (CA19-9) is a prognostic marker for patients with pancreatic cancer (PC), but its value as a treatment biomarker is unclear.</jats:p> </jats:sec> <jats:sec> <jats:title>Summary Background Data:</jats:title> <jats:p>Although CA19-9 is an established prognostic marker for patients with PC, it is unclear how CA19-9 monitoring should be used to guide multimodality treatment and what level of change in CA19-9 constitutes a meaningful treatment response.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>CA19-9 measurements at diagnosis (pretx), after completion of all planned neoadjuvant therapy (preop), and after surgery (postop) were analyzed in patients with localized PC who had an elevated CA19-9 (≥35 U/dL) at diagnosis. Patients were classified by: 1) quartiles of pretx CA19-9 (Q1-4); 2) proportional changes in CA19-9 (ΔCA19-9) after the completion of neoadjuvant therapy; 3) normalization (CA19-9 &lt;35 U/dL) of preop CA19-9; and 4) normalization of postop CA19-9.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Among 131 patients, the median overall survival (OS) was 30 months; 68 months for the 33 patients in Q1 of pretx CA19-9 (&lt;80 U/dL) compared with 25 months for the 98 patients in Q2-4 (<jats:italic toggle="yes">P</jats:italic> = 0.03). For the 98 patients in Q2-4, preop CA19-9 declined (from pretx) in 86 (88%), but there was no association between the magnitude of ΔCA19-9 and OS (<jats:italic toggle="yes">P</jats:italic> = 0.77). Median OS of the 98 patients who did (n = 29) or did not (n = 69) normalize their preop CA19-9 were 46 and 23 months, respectively (<jats:italic toggle="yes">P</jats:italic> = 0.02). Of the 69 patients with an elevated preop CA19-9, 32 (46%) normalized their postop CA19-9. Failure to normalize preop or postop CA19-9 was associated with a 2.77-fold and 4.03-fold increased risk of death, respectively (<jats:italic toggle="yes">P</jats:italic> &lt; 0.003) as compared with patients with normal preop CA19-9.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Following neoadjuvant therapy, normalization of CA19-9, rather than the magnitude of change, is the strongest prognostic marker for long-term survival.</jats:p> </jats:sec>