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CA19-9 Normalization During Pre-operative Treatment Predicts Longer Survival for Patients with Locally Progressed Pancreatic Cancer

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Compared to the widely adopted 2–4 months of pre-operative therapy for patients with borderline resectable (BR) or locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC), our institution tends to administer a longer duration before considering surgical resection. Using this unique approach, the aim of this study was to determine pre-operative variables associated with survival.

Methods

Records from patients with BR/LA PDAC who underwent attempt at surgical resection from 1992–2014 were reviewed.

Results

After a median duration of 6 months of pre-operative treatment, 109 patients with BR/LA PDAC (BR 63, LA 46) were explored; 93 (85.3 %) underwent pancreatectomy. Those who received at least 6 months of pre-operative treatment had longer median overall survival (OS) than those who received less (52.8 vs. 32.1 months, P = 0.044). On multivariate analysis, pre-operative treatment duration was the strongest predictor of survival (hazard ratio (HR) 4.79, P = 0.043). However, OS was similar in those whose CA19-9 normalized regardless of whether they received more or less than 6 months of chemotherapy (71.4 vs. 101.8 months, P = 0.930).

Conclusions

Pre-operative CA19-9 decline can guide treatment duration in patients with BR/LA PDAC. We endorse 6 months of therapy except in those patients whose values normalize, where surgery can be considered after a shorter course.

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Authors and Affiliations

  1. Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, 90502, USA

    Jennifer L. Williams

  2. Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA

    Brian E. Kadera, Andrew H. Nguyen, O. Joe Hines, Howard A. Reber & Timothy R. Donahue

  3. Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA

    V. Raman Muthusamy & Zev A. Wainberg

  4. Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, 72-215 CHS, Box 956904, Los Angeles, CA, 90095, USA

    Timothy R. Donahue

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  1. Jennifer L. Williams
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  2. Brian E. Kadera
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  4. V. Raman Muthusamy
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Correspondence to Timothy R. Donahue.

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Williams, J.L., Kadera, B.E., Nguyen, A.H. et al. CA19-9 Normalization During Pre-operative Treatment Predicts Longer Survival for Patients with Locally Progressed Pancreatic Cancer. J Gastrointest Surg 20, 1331–1342 (2016). https://doi.org/10.1007/s11605-016-3149-4

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  • DOI: https://doi.org/10.1007/s11605-016-3149-4

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