Serum CA 19-9 as a Marker of Resectability and Survival in Patients with Potentially Resectable Pancreatic Cancer Treated with Neoadjuvant Chemoradiation
- Matthew H. G. Katz MD,
- Gauri R. Varadhachary MD,
- Jason B. Fleming MD,
- Robert A. Wolff MD,
- Jeffrey E. Lee MD,
- Peter W. T. Pisters MD,
- Jean-Nicolas Vauthey MD,
- Eddie K. Abdalla MD,
- Charlotte C. Sun DrPH, MPH,
- Huamin Wang MD, PhD,
- Christopher H. Crane MD,
- Jeffrey H. Lee MD,
- Eric P. Tamm MD,
- James L. Abbruzzese MD,
- Douglas B. Evans MD
- … show all 15 hide
The role of carbohydrate antigen (CA) 19-9 in the evaluation of patients with resectable pancreatic cancer treated with neoadjuvant therapy prior to planned surgical resection is unknown. We evaluated CA 19-9 as a marker of therapeutic response, completion of therapy, and survival in patients enrolled on two recently reported clinical trials.
Patients and Methods
We analyzed patients with radiographically resectable adenocarcinoma of the head/uncinate process treated on two phase II trials of neoadjuvant chemoradiation. Patients without evidence of disease progression following chemoradiation underwent pancreaticoduodenectomy (PD). CA 19-9 was evaluated in patients with a normal bilirubin level.
We enrolled 174 patients, and 119 (68%) completed all therapy including PD. Pretreatment CA 19-9 <37 U/ml had a positive predictive value (PPV) for completing PD of 86% but a negative predictive value (NPV) of 33%. Among patients without evidence of disease at last follow-up, the highest pretreatment CA 19-9 was 1,125 U/ml. Restaging CA 19-9 <61 U/ml had a PPV of 93% and a NPV of 28% for completing PD among resectable patients. The area under the receiver-operating characteristics curve of pretreatment and restaging CA 19-9 levels for completing PD was 0.59 and 0.74, respectively. We identified no association between change in CA 19-9 and histopathologic response (P = 0.74).
Although the PPV of CA 19-9 for completing neoadjuvant therapy and undergoing PD was high, its clinical utility was compromised by a low NPV. Decision-making for patients with resectable PC should remain based on clinical assessment and radiographic staging.
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- Serum CA 19-9 as a Marker of Resectability and Survival in Patients with Potentially Resectable Pancreatic Cancer Treated with Neoadjuvant Chemoradiation
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Annals of Surgical Oncology
Volume 17, Issue 7 , pp 1794-1801
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- Matthew H. G. Katz MD (1)
- Gauri R. Varadhachary MD (2)
- Jason B. Fleming MD (3)
- Robert A. Wolff MD (2)
- Jeffrey E. Lee MD (3)
- Peter W. T. Pisters MD (3)
- Jean-Nicolas Vauthey MD (3)
- Eddie K. Abdalla MD (3)
- Charlotte C. Sun DrPH, MPH (4)
- Huamin Wang MD, PhD (5)
- Christopher H. Crane MD (6)
- Jeffrey H. Lee MD (7)
- Eric P. Tamm MD (8)
- James L. Abbruzzese MD (2)
- Douglas B. Evans MD (9)
- Author Affiliations
- 1. Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, The University of California at Irvine, Orange, CA, USA
- 2. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 3. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 4. Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 5. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 6. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 7. Department of Gastroenterology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 8. Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- 9. Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA