Exploring racial disparities and tumor characteristics of CA19-9 producer and non-producer among patients with advanced pancreatic ductal adenocarcinoma (PDAC): Implications for survival and personalized treatment strategies.

Abstract

e16309 Background: Despite substantial progress in cancer treatment, PDAC remains a highly lethal disease. CA19-9 plays a crucial role in PDAC diagnosis and therapeutic response assessment. We aimed to evaluate racial differences, tumor characteristics, and outcomes between CA19-9 non-producers and producers among advanced PDAC patients (pts) at an academic teaching hospital. Methods: A retrospective analysis was conducted in patients with unresectable or metastatic PDAC treated at Mount Sinai Health System between January 2012 and December 2021. Pts were categorized into two groups based on CA19-9 levels, using a threshold of 37 U/mL: CA19-9 non-producers (≤37 U/mL) and CA19-9 producers ( > 37 U/mL). Demographic and clinical data were compared between the two groups, and the association between CA19-9 levels and overall survival (OS) was assessed using Kaplan-Meier estimates and multivariable Cox proportional hazards regression models. Results: A total of 238 pts were included in the analysis, with a median age of 67 years and a balanced gender distribution (52% male). The cohort comprised locally advanced (29.8%) and metastatic (70.2%) cases, with a diverse ethnic composition including non-Hispanic whites (37%), non-Hispanic blacks (25%), and Hispanics (18%). Among the pts, 23.5% were CA19-9 non-producers, while 76.5% were CA19-9 producers. Significant racial differences were observed, with non-Hispanic blacks more likely to be CA19-9 non-producers compared to non-Hispanic whites ( P< 0.001). However, no statistically significant differences were found in age, smoking status, tumor location, size, or site of metastasis between the two groups. Median overall survival (OS) was 13m for CA19-9 producers and 16m for non-producers, but this difference was not statistically significant in both univariate and multivariate analyses (HR 1.09, 95% CI 0.74-1.58, P = 0.66; HR 1.06, 95% CI 0.72-1.58, P 0.8). Hispanic ethnicity was correlated with improved OS (HR 0.59, 95% CI 0.36-0.95, P = 0.029), while larger tumor size predicted worse OS (HR 1.17, P < 0.001). Conclusions: This study highlights racial disparities in CA19-9 production among locally advanced and metastatic PDAC patients. Despite observed differences, CA19-9 levels alone did not emerge as a statistically significant predictor of OS. Future research should delve deeper into the racial disparities observed in CA19-9 production, exploring underlying biological mechanisms and potential implications for diagnostic and therapeutic approaches as this could refine our understanding of PDAC, facilitating targeted interventions for improved patient outcomes.