Postoperative CA19-9 and Glasgow prognostic score to predict early recurrence and poor prognosis in pancreatic cancer patients undergoing adjuvant chemotherapy after surgery.

Abstract

198 Background: Despite proven benefit of adjuvant chemotherapy in pancreatic cancer patients, earlyrecurrenceoccursinaconsiderablerate. Therefore, outcomeprediction in these patients remains a challenge. The aim of this study was to determine whether Glasgow Prognostic Score (GPS) and CA19-9 could predict early recurrence in patients undergoing adjuvant chemotherapy after surgery. Methods: 67 pancreatic ductal adenocarcinoma (PDAC) patients underwent curative resection and received adjuvant chemotherapy with gemcitabine after surgery at Kanagawa Cancer Center between 2007 and 2012.The GPS, CA19-9(measured prior to adjuvant therapy) and other clinicopathological factors were retrospectively reviewed. The GPS was calculated from CRP and albumin as follows: patients with both an elevated CRP level (>0.5mg/dl) and hypoalbuminemia (<3.5g/dl) were allocated a score of 2, patients with only one of these biochemical abnormalities were allocated a score of 1, and patients with neither of these abnormalities were allocated a score of 0. Patients were divided to high and low CA19-9 group with cutoff points of 180 U/ml, on the basis of several RCT trials. Univariate and multivariate analyses were performed to identify clinicopathological variables associated with early recurrence (within 6 months after surgery), disease free survival (DFS), and overall survival (OS). Results: Postoperative elevated GPS and CA19-9 were independent risk factors for early recurrence. Positive/negative predictive value (PPV/NPV) were 0.86/0.54 in GPS and 0.84/0.69 in CA19-9 respectively, and in combination use, the PPV/NPV increased to 0.88/0.82. Additionally, the elevated GPS and CA19-9 were independently associated with worse DFS (GPS GHR1.95, 95%CI 1.03-3.69, p=0.042)(CA19-9 GHR5.03, 95%CI 2.05-12.3, p<0.001)and OS (GPS; HR5.29, 95%CI 2.14-13.1, p<0.01, CA19-9 GHR4.79, 95%CI 1.99-11.5, p<0.001). Conclusions: Our results show the potential utility of GPS and CA19-9 as a predictor of early recurrence and prognostic factor in pancreatic cancer.