Prognostic significance of preoperative and postoperative CA 19-9 normalization in pancreatic adenocarcinoma treated with neoadjuvant therapy or surgery first

DiPeri, T.P.; Newhook, T.E.; Prakash, L.R.; Ikoma, N.; Maxwell, J.E.; Kim, M.P.; Lee, J.E.; Katz, M.H.G.; Tzeng, C.-W.D.; DiPeri, T.P; Newhook, T.E; Prakash, L.R; Ikoma, N; Maxwell, J.E; Kim, M.P; Lee, J.E; Katz, M.H.G; Tzeng, C.-W.D

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Prognostic significance of preoperative and postoperative CA 19-9 normalization in pancreatic adenocarcinoma treated with neoadjuvant therapy or surgery first

DiPeri, T.P.; Newhook, T.E.; Prakash, L.R.; Ikoma, N.; Maxwell, J.E.; Kim, M.P.; Lee, J.E.; Katz, M.H.G.; Tzeng, C.-W.D.

Journal of Surgical Oncology 126(6): 1021-1027

2022

ISSN/ISBN: 1096-9098

PMID: 35726394

Accession: 080453536

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Summary

Normal(ization) of serum carbohydrate 19-9 (CA19-9) before/after surgery has not been compared in patients with pancreatic adenocarcinoma (PDAC) treated with neoadjuvant therapy (NT) versus surgery-first (SF). Characteristics for patients with PDAC who underwent resection from July 2011 to October 2018 were collected. Patients with pre-/postoperative CA19-9, bilirubin <2 mg/dL, and initial CA19-9 > 1 U/ml were included. Overall survival (OS) and recurrence-free survival (RFS) were compared by pre-/postoperative CA19-9. In patients receiving NT, normal pre/postoperative CA19-9 ("NTnl/nl ") was associated with median RFS and OS (26 and 77mo), followed by those who normalized after surgery ("NTabnl/nl " 16 and 44mo). For SF patients, normal pre-/postoperative CA19-9 ("SFnl/nl ") was associated with median RFS and OS (115 and not estimable mo), followed by those who normalized after resection ("SFabnl/nl " 18 and 49mo). Groups "NTabnl/abnl " and "SFabnl/abnl " with elevated CA19-9 both before and after resection had the worst median RFS and OS durations. While a normal(ized) postoperative CA19-9 may result in similar survival as preoperative normal(ization), postoperative normalization failed to occur in nearly 30% of SF patients. NT should be considered in patients presenting with elevated CA19-9. If considering SF, ideal patients may include those with normal CA19-9 at presentation.