Abstract
BackgroundCA19–9 decrease during treatment has been associated with superior survival of pancreatic cancer in several studies. The evidence to show the correlation of high platelet level with inferior survival is insufficient in pancreatic cancer. It also remains unclear whether the association between CA19–9 decrease and survival was corresponded to different levels of platelet in metastatic pancreatic cancer.MethodsWe measured CA19–9 serum concentration and platelet level at baseline and after the second cycle of chemotherapy for 200 advanced pancreatic cancer patients. A Cox proportional hazards model was used to compute mortality hazard ratios (HRs) for CA19–9 decrease, adjusting for potential confounders, including age, sex, KPS, prediagnosis body mass index, Diabetes Mellitus, tumor location, first-line chemotherapy regimen, and radiotherapy.ResultsWe found that the association of CA19–9 decrease with superior overall survival was stronger in advanced pancreatic cancer with a low level of platelet (Pinteraction < 0.001) compared with intermediate and high level of platelet. Multivariable-adjusted hazard ratios per unit decrease of CA19–9 change was 0.45 [95% confidence interval (CI), 0.33 to 0.62] in cases with low platelet level, 0.74 (95% CI, 0.50 to 1.09) in cases with intermediate platelet level, and 0.94 (95% CI, 0.74 to 1.10) in cases with high platelet level. A similar differential association was found between CA19–9 decrease and progression-free survival in strata of platelet level (Pinteraction = 0.034).ConclusionThe association of CA19–9 decrease with superior pancreatic cancer survival appeared to be pronounced in patients with a low platelet level. This finding could provide supports for the underlying mechanisms of CA19–9 involved in platelet / tumor cell interaction.
Highlights
Carbohydrate antigen 19–9 (CA19–9) decrease during treatment has been associated with superior survival of pancreatic cancer in several studies
The median overall survival (OS) in this group of patients was 7.91 months and median progression-free survival (PFS) was 5.29 months (95%confidence interval (CI), 1.48–17.28)
Of the 200 patients, the median baseline CA19–9 level was 1364.5 U/ml, median change after 6 weeks was decreased by 22% compared with baseline level (Table 1)
Summary
CA19–9 decrease during treatment has been associated with superior survival of pancreatic cancer in several studies. The evidence to show the correlation of high platelet level with inferior survival is insufficient in pancreatic cancer. It remains unclear whether the association between CA19–9 decrease and survival was corresponded to different levels of platelet in metastatic pancreatic cancer. The contribution of platelets to tumor metastatic has been revealed since 1960s by in vivo experiments [7] Platelets and their releasates can sustain proliferative signals, resist cell death, induce angiogenesis, activate invasion and metastasis and evade immune detection, support cancer stem cells, and even protect circulating tumor cells [8]. The association of high platelet level with inferior survival in pancreatic cancer is inconclusive
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