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

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.