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Serum CA 19-9 Response to Neoadjuvant Therapy is Associated with Outcome in Pancreatic Adenocarcinoma

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Baseline carbohydrate antigen 19-9 (CA 19-9) is a useful prognostic marker in pancreatic ductal adenocarcinoma (PDA); however, data on the significance of a change in CA 19-9 following neoadjuvant therapy are lacking.

Methods

All patients receiving neoadjuvant therapy for PDA from July 2010 to February 2013 were retrospectively reviewed. Resection rate, R0 resection rate, need for venous resection, and overall survival were correlated to CA 19-9 response. Fisher’s exact test, Kaplan–Meier survival analysis, and multivariate analysis using Cox regression were used.

Results

A total of 78 patients were studied (21 patients with resectable disease, 40 borderline resectable, and 17 with locally advanced disease). A variety of chemotherapies ± radiation were utilized during the study period. Overall, 56 patients (72 %) had a decrease in CA 19-9 of >50 % with neoadjuvant treatment. In borderline resectable patients, CA 19-9 response of >50 % predicted R0 resection (odds ratio 4.2; p = 0.05). In borderline resectable patients who had an increase in CA 19-9, none of five (0 %) underwent R0 resection compared with 80 % of the remaining cohort (p = 0.001). The complete pathologic response rate was 29 % in patients who had a CA 19-9 response of >90 % versus 0 % in the remaining patients (p < 0.001). A CA 19-9 response of >50 % resulted in improved overall survival (28.0 vs. 11.1 months; p < 0.0001) and was an independent predictor of survival (hazard ratio 0.26; 95 % CI 0.13–0.55; p < 0.0001).

Conclusions

CA 19-9 response to neoadjuvant therapy is associated with R0 resection rate, histopathologic response, and survival. Incorporation of this easily obtainable biomarker into future clinical trials may facilitate more rapid evaluation of novel regimens.

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Acknowledgment

The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. This work was supported by grant number T32CA113263 from the National Cancer Institute.

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Authors and Affiliations

  1. Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Brian A. Boone, Jennifer Steve, Mazen S. Zenati, Melissa E. Hogg, David L. Bartlett, Amer H. Zureikat & Herbert J. Zeh III

  2. Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA

    Aatur D. Singhi

  3. Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Nathan Bahary

Authors
  1. Brian A. Boone
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  2. Jennifer Steve
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  3. Mazen S. Zenati
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  4. Melissa E. Hogg
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  9. Herbert J. Zeh III
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Correspondence to Herbert J. Zeh III.

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Boone, B.A., Steve, J., Zenati, M.S. et al. Serum CA 19-9 Response to Neoadjuvant Therapy is Associated with Outcome in Pancreatic Adenocarcinoma. Ann Surg Oncol 21, 4351–4358 (2014). https://doi.org/10.1245/s10434-014-3842-z

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  • DOI: https://doi.org/10.1245/s10434-014-3842-z

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