Predicting Adverse Pathologic Features and Clinical Outcomes of Resectable Pancreas Cancer With Preoperative CA 19-9

Frontiers in Oncology

Wen Wee Ma¹  Amit Mahipal¹  Robert R. McWilliams¹  Thorvardur R. Halfdanarson¹  Mark J. Truty²  Rory L. Smoot²  Sean P. Cleary²  Lizhi Zhang³  Rondell P. Graham³  Hunter C. Gits⁴  Kenneth W. Merrell⁴  Scott C. Lester⁴  Robert C. Miller⁴  Roman O. Kowalchuk⁴  Michelle A. Neben Wittich⁴  Dawn Owen⁴  Michael G. Haddock⁴  Christopher L. Hallemeier⁴  William S. Harmsen⁵ 

[1] Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States;Department of Pancreas Surgery, Mayo Clinic, Rochester, MN, United States;Department of Pathology, Mayo Clinic, Rochester, MN, United States;Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States;Department of Statistics, Mayo Clinic, Rochester, MN, United States;

关键词: pancreatic cancer;    CA19-9;    prognostic factors;    neoadjuvant;    resection;   

DOI  :  10.3389/fonc.2021.651119

来源: DOAJ

【 摘 要 】

BackgroundWe evaluated preoperative CA 19-9 levels in patients with resected pancreatic cancer to analyze whether they were predictive of clinical outcomes and could help select patients for additional therapy. We hypothesized that elevated CA 19-9 would be associated with worse pathologic findings and oncologic outcomes.MethodsThis study assessed 509 patients with non-metastatic pancreatic adenocarcinoma who underwent resection at our institution from 1995-2011 and had preoperative CA 19-9 recorded. No patients received neoadjuvant therapy. CA 19-9 level was analyzed as a continuous and a dichotomized (> vs. ≤ 55 U/mL) variable using logistic and Cox models.ResultsMedian follow-up was 7.8 years, and the median age was 66 years (33-90). 64% of patients had elevated preoperative CA 19-9 (median: 141 U/mL), that did not correlate with bilirubin level or tumor size. Most patients had ≥ T3 tumors (72%) and positive lymph nodes (62%). The rate of incomplete (R1 or R2) resection was 19%. Increasing preoperative CA 19-9 was associated with extra-pancreatic extension (p=0.0005), lymphovascular space invasion (p=0.0072), incomplete resection [HR (95% CI) 2.0 (1.2-3.5)], and lower OS [HR = 1.6 (1.3-2.0)]. Each doubling in preoperative CA 19-9 value was associated with an 8.3% increased risk of death [HR = 1.08 (1.02-1.15)] and a 10.0% increased risk of distant recurrence [HR = 1.10 (1.02-1.19)]. Patients classified as non-secretors had comparable outcomes to patients with normal CA 19-9.ConclusionsElevated preoperative CA 19-9 level was associated with adverse pathologic features, incomplete resection, and inferior clinical outcomes. Neither tumor size nor bilirubin confound an elevated CA 19-9 level. Preoperative CA 19-9 level may help select patients for additional therapy.

【 授权许可】

Unknown