Analysis of prognostic factors for borderline resectable pancreatic cancer after neoadjuvant chemotherapy: the importance of CA19-9 decrease in patients with elevated pre-chemotherapy CA19-9 levels |
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| Institution: | 1. Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan;2. Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan;3. Department of Diagnostic Imaging, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan;1. Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), Shanghai, China;2. Graduate School, Hebei North University, Hebei, China;3. Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People''s Hospital, Affiliated People''s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China;4. Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong, China;5. Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fujian, China;6. Department of Hepatobiliary Surgery, Pu''er People''s Hospital, Yunnan, China;7. Department of General Surgery, Ziyang First People''s Hospital, Sichuan, China;8. The First Department of General Surgery, The Fourth Hospital of Harbin, Heilongjiang, China;9. Department of Hepatobiliary Surgery, Fuyang People''s Hospital, Anhui, China;10. Department of General Surgery, Liuyang People''s Hospital, Hunan, China;11. Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China;12. School of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang, China;13. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China;14. Eastern Hepatobiliary Clinical Research Institute, Third Affiliated Hospital of Navy Medical University, Shanghai, China;1. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA;2. Department of Radiology, John Hopkins University, Baltimore, MD, USA;1. Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria;2. Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy;3. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden;4. University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General-, Visceral-, Transplant- and Thoracic Surgery, Frankfurt am Main, Germany;5. Department of General Surgery, Medical University of Vienna, Vienna, Austria;6. Department of Hepatobiliary Surgery, St James''s University Hospital, Leeds, UK;7. Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK;8. Aintree University Hospital, Liverpool, UK;9. Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands;10. Department of General Surgery, Medical University of Graz, Graz, Austria;11. Department of Surgery, Ordensklinikum Linz, Linz, Austria;12. Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria;13. Department of General, Visceral and Vascular Surgery, Salzkammergut Klinikum, Vöcklabruck, Austria;14. Faculty of Medicine and Health, The University of Sydney, Australia;15. Department of Gastroenterology, AORN Antonio Cardarelli, Naples, Italy;1. Department of Surgery and Cancer, Imperial College London, Du Cane Rd, London W12 0HS, United Kingdom;2. Surgery, Cardiovascular and Cancer Division, Imperial College Healthcare NHS Trust, Du Cane Rd, London W12 0HS, United Kingdom;3. Liver Anaesthesia, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2GW, United Kingdom;4. Liver Unit, Queen Elizabeth Hospital, Mindelsohn Way, Birmingham B15 2GW, United Kingdom;5. Centre for Peri-operative Medicine and Critical Care Research, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Rd, London W12 0HS, United Kingdom;6. Department of Surgery and Cancer, Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, Du Cane Rd, London W12 0HS, United Kingdom |
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| Abstract: | BackgroundNeoadjuvant chemotherapy (NAC) is widely used to treat borderline resectable pancreatic cancer. This study aimed to evaluate the serum carbohydrate antigen (CA)19-9 response, in association with survival, after four cycles of NAC-gemcitabine plus nab-paclitaxel.MethodsFrom 2015 to 2018, patients with borderline resectable pancreatic cancer were treated with NAC. Patients were stratified into two groups after excluding CA19-9 non-secretor: Group L (CA19-9 ≥2 and ≤500 U/mL) and Group H (CA19-9 >500 U/mL). The CA19-9 decrease during NAC was evaluated as a response of NAC and was assessed in association with survival concomitant with other prognosis factors.ResultsEighty-seven patients were evaluated (Group L: n = 43, Group H: n = 44). In intention-to-treat-based analysis, Group L exhibited significantly better progression-free survival (PFS) than Group H (median PFS: 24 vs 14months). In resection cohort, no correlation was detected between the CA19-9 decrease and survival in Group L. In Group H, the CA19-9 decrease ≤80% was associated with unfavorable survival in multivariate analysis Hazard ratio: 4.738 (P = 0.007)].ConclusionIn patients with pre-treatment CA19-9 >500 U/mL, the CA19-9 decrease ≤80% was strongly associated with poor survival and new strategy should be reconsidered for these patients. |
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