Induction chemotherapy in pancreatic cancer: CA 19-9 may predict resectability and survival.

HPB : the Official Journal of the International Hepato Pancreato Biliary Association
Ulrike HegerThilo Hackert

Abstract

Preoperative/Neoadjuvant treatment (NT) is increasingly used in unresectable pancreatic cancer (PDAC). However, ∼40% of patients cannot be resected after NT and reliable preoperative response evaluation is currently lacking. We investigated CA 19-9 levels and their dynamics during NT for prediction of resectability and survival. We screened our institution's database for patients who underwent exploration or resection after NT with gemcitabine-based therapy (GEM) or FOLFIRINOX (FOL). Pre- and post-NT CA 19-9, resection rate and survival were analyzed. Of 318 patients 165 (51.9%) were resected and 153 (48.1%) received exploration. In the FOL group (n = 103; 32.4%), a post-NT CA 19-9 cutoff at 91.8 U/ml had a sensitivity of 75.0% and a specificity of 76.9% for completing resection with an AUC of 0.783 in the ROC analysis (95% CI: 0.692-0.874; p < 0.001. PPV: 84.2%, NPV: 65.2%). Resected patients above the cutoff did not benefit from resection. Post-NT CA 19-9 <91.8 U/ml (OR 11.63, p < 0.001) and CA 19-9 ratio of <0.4 (OR 5.77, p = 0.001) were independent predictors for resectability in FOL patients. CA 19-9 levels after neoadjuvant treatment with FOLFIRINOX predict resectability and survival of PDAC more accurately than dynamic v...Continue Reading

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Citations

Jan 30, 2020·Frontiers in Oncology·Ulla Klaiber, Thilo Hackert
Sep 6, 2020·Surgical Oncology·C SchwarzK Kaczirek
Sep 27, 2020·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·Tomoyuki AbeToshio Noriyuki
Feb 4, 2021·Annals of Gastroenterological Surgery·Keinosuke IshidoTaiichi Wakiya
Jan 14, 2021·World Journal of Gastrointestinal Surgery·Tsinrong LeeVishal G Shelat
Apr 9, 2021·Journal of Surgical Oncology·Zachary J Brown, Jordan M Cloyd
Nov 28, 2021·Journal of Clinical Medicine·Monika Kapszewicz, Ewa Małecka-Wojciesko

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