Abstract
BackgroundWe evaluated preoperative CA 19-9 levels in patients with resected pancreatic cancer to analyze whether they were predictive of clinical outcomes and could help select patients for additional therapy. We hypothesized that elevated CA 19-9 would be associated with worse pathologic findings and oncologic outcomes.MethodsThis study assessed 509 patients with non-metastatic pancreatic adenocarcinoma who underwent resection at our institution from 1995-2011 and had preoperative CA 19-9 recorded. No patients received neoadjuvant therapy. CA 19-9 level was analyzed as a continuous and a dichotomized (> vs. ≤ 55 U/mL) variable using logistic and Cox models.ResultsMedian follow-up was 7.8 years, and the median age was 66 years (33-90). 64% of patients had elevated preoperative CA 19-9 (median: 141 U/mL), that did not correlate with bilirubin level or tumor size. Most patients had ≥ T3 tumors (72%) and positive lymph nodes (62%). The rate of incomplete (R1 or R2) resection was 19%. Increasing preoperative CA 19-9 was associated with extra-pancreatic extension (p=0.0005), lymphovascular space invasion (p=0.0072), incomplete resection [HR (95% CI) 2.0 (1.2-3.5)], and lower OS [HR = 1.6 (1.3-2.0)]. Each doubling in preoperative CA 19-9 value was associated with an 8.3% increased risk of death [HR = 1.08 (1.02-1.15)] and a 10.0% increased risk of distant recurrence [HR = 1.10 (1.02-1.19)]. Patients classified as non-secretors had comparable outcomes to patients with normal CA 19-9.ConclusionsElevated preoperative CA 19-9 level was associated with adverse pathologic features, incomplete resection, and inferior clinical outcomes. Neither tumor size nor bilirubin confound an elevated CA 19-9 level. Preoperative CA 19-9 level may help select patients for additional therapy.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) represents the fourth leading cause of cancer death in the United States [1]
We evaluated a large cohort of patients to assess the association of preoperative elevated CA 19-9 level with adverse pathologic features and clinical endpoints
In the era of neoadjuvant therapy for pancreas cancer, we aim to evaluate the potential of preoperative CA 19-9 level as a key tool to optimize patient selection for neoadjuvant therapy
Summary
Pancreatic ductal adenocarcinoma (PDAC) represents the fourth leading cause of cancer death in the United States [1]. Clinical trials support the standard role of adjuvant chemotherapy though routine use of adjuvant radiation therapy remains controversial [3,4,5, 7,8,9,10,11,12,13]. Several recent clinical trials show that neoadjuvant chemotherapy followed by chemoradiation may improve the rates of R0 resection, lymph node sterilization, local control, and possibly overall survival (OS) compared to upfront resection, with benefits likely being greatest for patients with borderline resectable pancreas cancer [6, 14,15,16]. We evaluated preoperative CA 19-9 levels in patients with resected pancreatic cancer to analyze whether they were predictive of clinical outcomes and could help select patients for additional therapy. We hypothesized that elevated CA 19-9 would be associated with worse pathologic findings and oncologic outcomes
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