Differential impact of incrementally elevated CA 19-9 levels on prognosis of resected pancreatic ductal adenocarcinoma

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Hpb Pub Date : 2024-10-01 DOI:10.1016/j.hpb.2024.06.004

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Abstract

Background

CA 19–9 is an extremely useful biomarker for pancreatic ductal adenocarcinomas (PDACs). However, the optimal cut-off and prognostic significance at higher cut-offs are yet to be determined.

Methods

Retrospective analysis included patients with PDAC who underwent curative resection from January 2010 to May 2020 at Tata Memorial Centre, Mumbai. The pretherapy CA 19–9 was dichotomized using various cut-off levels and analysed.

Results

In 244 included patients, the median overall survival (OS) for those with CA19-9 level (IU/ml) < or >78, 200, 500, 1000, and 2000 was 27, 24, 23, 22, 21 months versus 18, 16, 15, 14, 13 months; respectively, and was statistically significant (p-value- 0.002, 0.001, 0.002, 0.002 and 0.004, respectively). The number of recurrences and mortality had significant correlation with CA 19–9 cut-offs. On multivariate analysis, adjuvant treatment completion (p-0.004) and decreasing or stable CA19-9 after Neoadjuvant therapy (NAT) (p- 0.031) were associated with improved OS.

Conclusion

The prognostic significance of CA 19–9 was observed at all the cut-off levels examined, beyond mere elevated value as per the standard cut-off level. In patients with high CA19-9 level, surgery should be offered if technically and conditionally feasible, only when a response in CA19-9 level to NAT is achieved.

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CA 19-9 水平逐渐升高对切除的胰腺导管腺癌预后的不同影响。

背景：CA 19-9是胰腺导管腺癌（PDAC）的一种非常有用的生物标志物。然而，最佳临界值和更高临界值的预后意义仍有待确定：回顾性分析包括2010年1月至2020年5月在孟买塔塔纪念中心接受根治性切除术的PDAC患者。采用不同的截断水平对治疗前的CA 19-9进行二分法分析：在纳入的244例患者中，CA19-9水平（IU/ml）<或>78、200、500、1000和2000的患者的中位总生存期（OS）分别为27、24、23、22和21个月，而CA19-9水平<或>78、200、500、1000和2000的患者的中位总生存期分别为18、16、15、14和13个月，差异具有统计学意义（P值分别为0.002、0.001、0.002、0.002和0.004）。复发次数和死亡率与 CA 19-9 临界值有显著相关性。在多变量分析中，辅助治疗完成（p-0.004）和新辅助治疗（NAT）后CA19-9下降或稳定（p- 0.031）与OS改善相关：结论：CA19-9在所有检查的截断水平上都具有预后意义，而不仅仅是标准截断水平上的升高值。对于 CA19-9 水平较高的患者，只有在 CA19-9 水平对 NAT 有反应时，才应在技术和条件可行的情况下进行手术治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).