Sustained elevation of CA19-9 after resection is a strong prognostic factor for resectable pancreatic cancer

Abstract

Introduction: Although standard therapy for resectable pancreatic ductal adenocarcinoma (R-PDAC) is discussed to perform upfront surgery, surgical outcomes still remain poor and predictors of recurrence are not to be determined. The aim of this study is to investigate the prognostic significance of pre-/post-operative CA19-9 status. Methods: A total of consecutive 176 patients with R-PDAC underwent upfront pancreatectomy between April 2007 and June 2019 were analyzed retrospectively. Among the 151 patients enrolled, we divided into 3 groups by CA19-9 status, group A (without elevation of preCA19-9; n=54), group B (with normalized postCA19-9; n=60) and group C (with elevation of postCA19-9; n=37). The relationship between CA19-9 status, survival and other clinicopathological features were analyzed. Results: PostCA19-9 were measured within 3 months after surgery (20-88 days, median; 43 days). Group C patients showed significantly poorer survival (group A/B/C; 3-year OS 61.9% /53.4% /12.4%; median survival time 44.2m /37.3m/ 13.6m; p< 0.001). The early recurrence rate within 6 month (p< 0.001) and the frequency of liver metastasis (p=0.009) were significantly higher in Group C. Multivariate analysis revealed that without adjuvant chemotherapy (HR=3.29; p< 0.001), preoperative-CT tumor size>20mm (HR=2.76; p< 0.001) and sustained elevation of postCA19-9 (HR=2.49; p=0.0017) were the independent significant prognostic factors for poor survival. The ROC curve analysis revealed that the optimal cut-off value of preCA19-9 which predict postCA19-9 normalization was 116 U/ml. Conclusion: Sustained elevation of postCA19-9 is a strong prognostic factor for R-PDAC. Patients with preCA19-9>120 could be considered the existence of potential distant metastasis (especially liver metastasis).