Abstract
BackgroundLife expectancy of pancreatic ductal adenocarcinoma (PDAC) patients is usually short and selection of the most appropriate treatment is crucial. The aim of this study was to investigate the usefulness of serum CA 19-9 as a surrogate marker under no impress excluding other factors affecting CA 19-9 level other than tumor itself.MethodsWe recruited 1,446 patients with PDACs and patients with Lewis antigen both negative or obstructive jaundice were excluded to eliminate the false effects on CA 19-9 level. The clinicopathologic factors were reviewed including initial and post-treatment CA 19-9, and statistical analysis was done to evaluate the association of clinicopathologic factors with overall survival (OS).ResultsThe total of 944 patients was enrolled, and205 patients (22%) underwent operation with curative intention and 541 patients (57%) received chemotherapy and/or radiotherapy. The median CA 19-9 levels of initial and post-treatment were 670 IU/ml and 147 IU/ml respectively. The prognostic factors affecting OS were performance status, AJCC stage and post-treatment CA 19-9 level in multivariate analysis. Subgroup analysis was done for the patients who underwent R0 and R1 resection, and patients with normalized post-operative CA 19-9 (≤37 IU/mL) had significantly longer OS and DFS regardless of initial CA 19-9 level; 32 vs. 18 months, P<0.001, 16 vs. 9 months, P = 0.004 respectively.ConclusionsPost-treatment CA 19-9 and normalized post-operative CA 19-9 (R0 and R1 resected tumors) were independent factors associated with OS and DFS, however, initial CA 19-9 level was not statistically significant in multivariate analysis.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) has poor prognosis with only 6% 5-year survival rate after its diagnosis [1]
The total of 1,572 patients was initially enrolled from the pancreatic cancer cohort registry, and patients with lost follow-ups and insufficient data were excluded from the study
Multivariate analysis was performed on factors with associated P values of,0.2 by univariate analysis and Cox proportional hazard model was used in multivariate analysis to identify independent factors associated with overall survival (OS) and disease-free survival (DFS)
Summary
Pancreatic ductal adenocarcinoma (PDAC) has poor prognosis with only 6% 5-year survival rate after its diagnosis [1]. Prognosis remains poor in spite of recent improvements of surgical management and adjuvant therapy [4]. It would be explained by late stage presentation, lack of effective treatments, early recurrence and absence of clinically useful biomarker which can detect PDAC in its precursor form or earliest stages [5]. The aim of this study was to investigate the true meaning and the usefulness of CA 19-9 as a prognostic marker in treatment of PDACs excluding other factors affecting the level of CA 19-9 other than tumor itself. The aim of this study was to investigate the usefulness of serum CA 19-9 as a surrogate marker under no impress excluding other factors affecting CA 19-9 level other than tumor itself
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