Abstract
Background: The association between optimal carbohydrate antigen (CA) 19-9 concentration after neoadjuvant chemotherapy (NACT) and prognosis has not been confirmed in patients with borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC). Methods: This retrospective study included 122 patients with BRPC and 103 with LAPC who underwent surgery after NACT between 2012 and 2019 in a tertiary referral center. Prognostic models were established based on relative difference of the CA 19-9 (RDC), with their prognostic performance compared using C-index and Akaike information criterion (AIC). Results: CA 19-9 concentrations of 37–1000 U/mL before NACT showed prognostic significance in patients with BRPC and LAPC (hazard ratio [HR]: 0.262; 95% confidence interval [CI]: 0.092–0.748; p = 0.012). Prognostic models in this subgroup showed that RDC was independently prognostic of better overall survival (HR: 0.262; 95% CI: 0.093–0.739; p = 0.011) and recurrence free survival (HR: 0.299; 95% CI: 0.140–0.642; p = 0.002). The prognostic performances of RDC (C-index: 0.653; AIC: 227.243), normalization of CA 19-9 after NACT (C-index: 0.625; AIC: 230.897) and surgery (C-index: 0.613; AIC: 233.114) showed no significant differences. Conclusion: RDC was independently associated with better prognosis after NACT in patients with BRPC or LAPC. Decreased CA19-9 after NACT was a prognostic indicator of better survival and recurrence, as was normalization of CA 19-9 after both NACT and surgery.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) is a rare gastrointestinal cancer, with patients having a dismal prognosis
Recent studies showed that patients with borderline resectable (BRPC) or locally advanced pancreatic cancer (LAPC) who underwent surgery after neoadjuvant chemotherapy (NACT) had better survival outcomes than those who underwent upfront surgery [3,4,5,6]
Several studies found that normalization of carbohydrate antigen (CA) 19-9 concentration is associated with better patient prognosis [9], 5–10% of patients with PDAC have normal CA 19-9 at diagnosis because of a Lewis-negative phenotype, and waiting until normalization of CA 19-9 is difficult in real-world practice [10,11]
Summary
Pancreatic ductal adenocarcinoma (PDAC) is a rare gastrointestinal cancer, with patients having a dismal prognosis. Recent studies showed that patients with borderline resectable (BRPC) or locally advanced pancreatic cancer (LAPC) who underwent surgery after neoadjuvant chemotherapy (NACT) had better survival outcomes than those who underwent upfront surgery [3,4,5,6]. The association between optimal carbohydrate antigen (CA) 19-9 concentration after neoadjuvant chemotherapy (NACT) and prognosis has not been confirmed in patients with borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC). Results: CA 19-9 concentrations of 37–1000 U/mL before NACT showed prognostic significance in patients with BRPC and LAPC (hazard ratio [HR]: 0.262; 95% confidence interval [CI]: 0.092–0.748; p = 0.012) Prognostic models in this subgroup showed that RDC was independently prognostic of better overall survival (HR: 0.262; 95% CI: 0.093–0.739; p = 0.011) and recurrence free survival (HR: 0.299; 95% CI: 0.140–0.642; p = 0.002). Decreased CA19-9 after NACT was a prognostic indicator of better survival and recurrence, as was normalization of CA 19-9 after both NACT and surgery
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