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. 2014 May;16(5):430-8.
doi: 10.1111/hpb.12154. Epub 2013 Aug 29.

Serum carbohydrate antigen 19-9 represents a marker of response to neoadjuvant therapy in patients with borderline resectable pancreatic cancer

Ching-Wei D Tzeng  1 , Aparna Balachandran, Mediha Ahmad, Jeffrey E Lee, Sunil Krishnan, Huamin Wang, Christopher H Crane, Robert A Wolff, Gauri R Varadhachary, Peter W T Pisters, Thomas A Aloia, Jean-Nicolas Vauthey, Jason B Fleming, Matthew H G Katz
Affiliations

Serum carbohydrate antigen 19-9 represents a marker of response to neoadjuvant therapy in patients with borderline resectable pancreatic cancer

Ching-Wei D Tzeng et al. HPB (Oxford). 2014 May.

Abstract

Objectives: The purpose of this study was to determine the relationship between carbohydrate antigen (CA) 19-9 levels and outcome in patients with borderline resectable pancreatic cancer treated with neoadjuvant therapy (NT).

Methods: This study included all patients with borderline resectable pancreatic cancer, a serum CA 19-9 level of ≥40 U/ml and bilirubin of ≤2 mg/dl, in whom NT was initiated at one institution between 2001 and 2010. The study evaluated the associations between pre- and post-NT CA 19-9, resection and overall survival.

Results: Among 141 eligible patients, CA 19-9 declined during NT in 116. Following NT, 84 of 141 (60%) patients underwent resection. For post-NT resection, the positive predictive value of a decline and the negative predictive value of an increase in CA 19-9 were 70% and 88%, respectively. The normalization of CA 19-9 (post-NT <40 U/ml) was associated with longer median overall survival among both non-resected (15 months versus 11 months; P = 0.022) and resected (38 months versus 26 months; P = 0.020) patients. Factors independently associated with shorter overall survival were no resection [hazard ratio (HR) 3.86, P < 0.001] and failure to normalize CA 19-9 (HR 2.13, P = 0.001).

Conclusions: The serum CA 19-9 level represents a dynamic preoperative marker of tumour biology and response to NT, and provides prognostic information in both non-resected and resected patients with borderline resectable pancreatic cancer.

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Figures

Figure 1
Figure 1
Flow diagram of patients selected for this study. CA 19-9, carbohydrate antigen 19-9 (serum)
Figure 2
Figure 2
Pattern of carbohydrate antigen (CA) 19-9 change after neoadjuvant therapy showing that 82% of patients experienced a decrease in CA 19-9
Figure 3
Figure 3
Receiver operating characteristic curves displaying associations of serum levels of carbohydrate antigen (CA) 19-9 before and after neoadjuvant therapy (NT) with resection after NT. The areas under the curve for pre-NT and post-NT CA 19-9 levels were 0.62 [95% confidence interval (CI) 0.52–0.71] and 0.78 (95% CI 0.70–0.86) with optimum cut-off values of 989 U/ml and 106 U/ml, respectively
Figure 4
Figure 4
Kaplan–Meier estimates of survival in all patients stratified by resection status and carbohydrate antigen (CA) 19-9 normalization after neoadjuvant therapy (NT)
See this image and copyright information in PMC

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