Prognostic significance of preoperative and postoperative CA 19‐9 normalization in pancreatic adenocarcinoma treated with neoadjuvant therapy or surgery first
Timothy P. DiPeri, Timothy E. Newhook, Laura R. Prakash, Naruhiko Ikoma, Jessica Maxwell, Michael P. Kim, Jeffrey E. Lee, Matthew H. G. Katz, Ching‐Wei D. Tzeng
Abstract
Abstract Background Normal(ization) of serum carbohydrate 19‐9 (CA19‐9) before/after surgery has not been compared in patients with pancreatic adenocarcinoma (PDAC) treated with neoadjuvant therapy (NT) versus surgery‐first (SF). Methods Characteristics for patients with PDAC who underwent resection from July 2011 to October 2018 were collected. Patients with pre‐/postoperative CA19‐9, bilirubin <2 mg/dL, and initial CA19‐9 > 1 U/ml were included. Overall survival (OS) and recurrence‐free survival (RFS) were compared by pre‐/postoperative CA19‐9. Results In patients receiving NT, normal pre/postoperative CA19‐9 (“NT nl/nl ”) was associated with median RFS and OS (26 and 77mo), followed by those who normalized after surgery (“NT abnl/nl ” 16 and 44mo). For SF patients, normal pre‐/postoperative CA19‐9 (“SF nl/nl ”) was associated with median RFS and OS (115 and not estimable mo), followed by those who normalized after resection (“SF abnl/nl ” 18 and 49mo). Groups “NT abnl/abnl ” and “SF abnl/abnl ” with elevated CA19‐9 both before and after resection had the worst median RFS and OS durations. Conclusions While a normal(ized) postoperative CA19‐9 may result in similar survival as preoperative normal(ization), postoperative normalization failed to occur in nearly 30% of SF patients. NT should be considered in patients presenting with elevated CA19‐9. If considering SF, ideal patients may include those with normal CA19‐9 at presentation.