The clinical impact of neoadjuvant therapy followed by surgery and CA19-9 level for locally advanced pancreatic cancer

Abstract

Introduction: Pancreatic cancer (PDAC) has a highly invasive and metastatic potential. To overcome this, curative resection with multidisciplinary therapy is crucial for the improvement of patients' prognosis. Herein, we compared the clinico-pathological parameters and outcomes between surgery first (SF) group and neoadjuvant therapy (NAT) group for treatment of patients with locally advanced pancreatic head cancer (BR, UR-LA PDAC). Methods: Consecutive all 137 patients with BR/UR-LA head-PDAC were performed pancreaticoduodenectomy or total pancreatectomy in our department from April 2002 to Oct 2016. Among all these patients, 63 and 44 patients in BR, and 12 and 18 patients in UR-LA were classified into SF and NAT groups, respectively. Results: Comparing between SF and NAT, no significant differences were observed in the major clinico-pathological factors. Median overall survival times of patients were 22.3 months for SF and 27.4 months for NAT in BR, and 9.5 months for SF and 18.7 months for NAT in UR-LA. Furthermore, the Kaplan-Meier analyses showed significantly better prognosis in NAT than those in SF, specifically in BR-A (p = 0.0054) and UR-LA (p = 0.0025). Focusing on the clinical significance of CA19-9 level, we determined whether CA19-9 level after NAT is useful as a surrogate marker for longer survival of patients after surgery. The analyses suggested that CA19-9 < 100 after NAT is a good prediction marker for longer survival of patients after operation. Conclusion: NAT is a crucial option in treatment for patients with BR/UR-LA PDAC. CA19-9 level after NAT might be a useful marker for determining optimal patients undergone surgery.