Sustained Carbohydrate Antigen 19-9 Response to Neoadjuvant Chemotherapy in Borderline Resectable Pancreatic Cancer Predicts Progression and Survival
Open Access
- 27 April 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in The Oncologist
- Vol. 25 (10), 859-866
- https://doi.org/10.1634/theoncologist.2019-0878
Abstract
Background As neoadjuvant therapy of borderline resectable pancreatic cancer (BRPC) is becoming more widely utilized, better indicators of progression are needed to help guide therapeutic decisions. Methods A retrospective review was performed on all patients with BRPC who received 24 weeks of neoadjuvant chemotherapy. Patients with chemotoxicity or medical comorbidities limiting treatment completion and non‐expressors of CA19‐9 were excluded. Serum CA19‐9 response was analyzed as a predictor of disease progression, recurrence, and survival. Results One hundred and four patients were included, 39 (37%) progressed on treatment (18 local and 21 distant), and 65 (63%) were resected (68% R0). Multivariate logistic regression analysis determined that the percent decrease in CA19‐9 from baseline to minimum value (OR 0.947, p=<.0001) and the percent increase from minimum value to final restaging CA19‐9 (OR 1.030, p=<.0001) were predictive of progression. ROC curve analysis determined cutoff values predictive of progression, which were utilized to create four prognostic groups. CA19‐9 responses were categorized as: 1) Always normal [n=6]; 2) Poor response [n=31]; 3) Unsustained response [n=19]; and 4) Sustained response [n=48]. Median overall survival for Groups 1‐4 were 58, 16, 20, and 38 months respectively (p=<0.0001). Conclusion Patients with initially elevated CA19‐9 levels who do not have a decline to a sustained low level are at risk for progression, recurrence, and poor survival. Alternative treatment strategies prior to an attempt at curative resection should be considered in this cohort. Implications for Practice This study identifies percent changes in CA19‐9 blood levels while on chemotherapy that predict tumor growth in patients with advanced pancreas cancer. These changes could be used to better select patients that would benefit from surgical removal of their tumors and improve survival.Keywords
This publication has 33 references indexed in Scilit:
- Serum carbohydrate antigen 19-9 represents a marker of response to neoadjuvant therapy in patients with borderline resectable pancreatic cancerHPB, 2014
- CA19-9 in Potentially Resectable Pancreatic Cancer: Perspective to Adjust Surgical and Perioperative TherapyAnnals of Surgical Oncology, 2012
- Diagnostic, prognostic, and predictive biomarkers in pancreatic cancerJournal of Surgical Oncology, 2012
- Selective Use of Staging Laparoscopy Based on Carbohydrate Antigen 19-9 Level and Tumor Size in Patients With Radiographically Defined Potentially or Borderline Resectable Pancreatic CancerPancreas, 2011
- Preoperative/Neoadjuvant Therapy in Pancreatic Cancer: A Systematic Review and Meta-analysis of Response and Resection PercentagesPLoS Medicine, 2010
- New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1)European Journal Of Cancer, 2009
- Preoperative CA 19-9 and the Yield of Staging Laparoscopy in Patients with Radiographically Resectable Pancreatic AdenocarcinomaAnnals of Surgical Oncology, 2008
- Borderline Resectable Pancreatic Cancer: The Importance of This Emerging Stage of DiseaseJournal of the American College of Surgeons, 2008
- Performance Characteristics of Five Automated CA 19-9 AssaysAmerican Journal of Clinical Pathology, 2007
- Influence of Lewis α1-3/4-L-Fucosyltransferase (FUT3) Gene Mutations on Enzyme Activity, Erythrocyte Phenotyping, and Circulating Tumor Marker Sialyl-Lewis a LevelsJournal of Biological Chemistry, 1996