Decreased serum carbohydrate antigen 19-9 levels after neoadjuvant therapy predict a better prognosis for patients with pancreatic adenocarcinoma: a multicenter case-control study of 240 patients

被引：80

作者：

Aoki, Shuichi ^{[1
]}

Motoi, Fuyuhiko ^{[1
]}

Murakami, Yoshiaki ^{[2
]}

Sho, Masayuki ^{[3
]}

Satoi, Sohei ^{[4
]}

Honda, Goro ^{[5
]}

Uemura, Kenichiro ^{[2
]}

Okada, Ken-ichi ^{[7
]}

Matsumoto, Ippei ^{[8
]}

Nagai, Minako ^{[3
]}

Yanagimoto, Hiroaki ^{[4
]}

Kurata, Masanao ^{[6
]}

Fukumoto, Takumi ^{[9
]}

Mizuma, Masamichi ^{[1
]}

Yamaue, Hiroki ^{[7
]}

Unno, Michiaki ^{[1
]}

机构：

[1] Tohoku Univ, Grad Sch Med, Dept Surg, Aoba Ku, 1-1 Seiryo Machi, Sendai, Miyagi 9808574, Japan

[2] Hiroshima Univ, Inst Biomed & Hlth Sci, Dept Surg, Hiroshima 7348553, Japan

[3] Nara Med Univ, Dept Surg, Nara 6348521, Japan

[4] Kansai Med Univ, Dept Surg, Osaka 5731010, Japan

[5] Komagome Hosp, Tokyo Metropolitan Canc & Infect Dis Ctr, Dept Surg, Tokyo 1138677, Japan

[6] Univ Tsukuba, Fac Med, Dept Gastointestinal & Hepatobiliary Pancreat Sur, Tsukuba, Ibaraki 3058575, Japan

[7] Wakayama Med Univ, Dept Surg 2, Wakayama 6418510, Japan

[8] Kindai Univ, Dept Surg, Fac Med, Osaka 5778502, Japan

[9] Kobe Univ, Grad Sch Med, Dept Surg, Kobe, Hyogo 6500017, Japan

来源：

BMC CANCER | 2019年 / 19卷 / 1期

基金：

日本学术振兴会;

关键词：

Carbohydrate antigen 19-9; Neoadjuvant therapy; Pancreatic cancer; GEMCITABINE-BASED CHEMORADIATION; LONG-TERM OUTCOMES; PREOPERATIVE GEMCITABINE; RESECTABLE ADENOCARCINOMA; ADJUVANT CHEMOTHERAPY; DUCTAL ADENOCARCINOMA; CA19-9; LEVELS; CANCER; RESECTION; SURVIVAL;

D O I：

10.1186/s12885-019-5460-4

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

BackgroundCarbohydrate antigen (CA) 19-9 levels after resection are considered to predict prognosis; however, the significance of decreased CA19-9 levels after neoadjuvant therapy has not been clarified. This study aimed to define the prognostic significance of decreased CA19-9 levels after neoadjuvant therapy in patients with pancreatic adenocarcinoma.MethodsBetween 2001 and 2012, 240 consecutive patients received neoadjuvant therapy and subsequent resection at seven high-volume institutions in Japan. These patients were divided into three groups: Normal group (no elevation [37U/ml] before and after neoadjuvant therapy), Responder group (elevated levels [>37U/ml] before neoadjuvant therapy but decreased levels [37U/ml] afterwards), and Non-responder group (elevated levels [>37U/ml] after neoadjuvant therapy). Analyses of overall survival and recurrence patterns were performed. Uni- and multivariate analyses were performed to clarify the clinicopathological factors influencing overall survival. The initial metastasis sites were also evaluated in these groups.ResultsThe Responder group received a better prognosis than the Non-responder group (3-year overall survival: 50.6 and 41.6%, respectively, P=0.026), but the prognosis was comparable to the Normal group (3-year overall survival: 54.2%, P=0.934). According to the analysis of the receiver operating characteristic curve, the CA19-9 cut-off level defined as no elevation after neoadjuvant therapy was 103U/ml. The multivariate analysis revealed that a CA19-9 level103U/ml, (P=0.010, hazard ratio: 1.711; 95% confidence interval: 1.133-2.639), tumor size 27mm (P=0.040, 1.517; (1.018-2.278)), a lack of lymph node metastasis (P=0.002, 1.905; (1.276-2.875)), and R0 status (P=0.045, 1.659; 1.012-2.627) were significant predictors of overall survival. Moreover, the Responder group showed a lower risk of hepatic recurrence (18%) compared to the Non-responder group (31%), though no significant difference in loco-regional, peritoneal or other distant recurrence were observed between groups (P=0.058, P=0.700 and P=0.350, respectively).ConclusionsDecreased CA19-9 levels after neoadjuvant therapy predicts a better prognosis, with low incidence of hepatic recurrence after surgery.

引用

页数：12

共 35 条

[21] Feasibility and Efficacy of Combination Therapy With Preoperative Full-Dose Gemcitabine, Concurrent Three-Dimensional Conformal Radiation, Surgery, and Postoperative Liver Perfusion Chemotherapy for T3-Pancreatic Cancer [J].