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Sustained Elevation of Postoperative Serum Level of Carbohydrate Antigen 19-9 is High-Risk Stigmata for Primary Hepatic Recurrence in Patients with Curatively Resected Pancreatic Adenocarcinoma

  • Fuyuhiko Motoi
  • Yoshiaki Murakami
  • Ken-ichi Okada
  • Ippei Matsumoto
  • Kenichiro Uemura
  • Sohei Satoi
  • Masayuki Sho
  • Goro Honda
  • Takumi Fukumoto
  • Hiroaki Yanagimoto
  • Shoichi Kinoshita
  • Masanao Kurata
  • Shuichi Aoki
  • Masamichi Mizuma
  • Hiroki Yamaue
  • Michiaki Unno
  • for the Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS)
Original Scientific Report (including Papers Presented at Surgical Conferences)

Abstract

Background

Survival after surgery for pancreatic adenocarcinoma (PA) is poor and heterogeneous, even for curative (R0) resection. Serum carbohydrate antigen (CA) 19-9 levels are important prognostic markers for resected PA. However, sustained elevation of CA19-9 in association with the patterns of recurrence has been rarely investigated.

Methods

Patients who underwent R0 resection (n = 539) were grouped according to postoperative serum CA19-9 levels (Group E: sustained elevation; Group N: no elevation). Clinicopathological factors, patterns of recurrence, and survival were compared between the groups.

Results

Group E (n = 159) had significantly shorter median overall survival (17.1 vs. 35.4 months, p < 0.0001) than Group N (n = 380). Postoperative CA19-9 elevation was a significant independent predictor of poor survival in multivariate analysis (hazard ratio 1.98, p < 0.0001). The rate of hepatic recurrence in Group E was 2.6-fold higher than in Group N (45% vs. 17%, p < 0.0001). Postoperative CA19-9 elevation was a strongest independent predictor of primary hepatic recurrence (p < 0.0001) by a multiple regression model. Loco-regional, peritoneal, and other distant recurrence did not differ between the groups. The extent of preoperative CA19-9 elevation was correlated sustained elevation of CA19-9 after surgery (p < 0.0001) and primary hepatic recurrence (p = 0.0019).

Conclusions

Sustained CA19-9 elevation was strong predictor of primary hepatic recurrence and short survival in cases of R0 resection for PA.

Notes

Acknowledgements

This study represents the work for seven academic medical institutions. This work required establishing uniform database at each institution and therefore required the work of multiple authors.

Funding

This work was supported in part by Grants-in-Aid for Scientific Research 24592018 and 16K10588 from the Japan Society for the Promotion of Science.

Compliance with ethical standards

Conflicts of interest

The authors have no potential conflicts of interest to disclose.

Supplementary material

268_2018_4814_MOESM1_ESM.pptx (98 kb)
Supplemental Figure: Relationship between the extent of postoperative CA19-9 and primary hepatic recurrence, recurrence-free survival. ULN indicated Upper Limit of Normal (37 U/ml) CA19-9 values (PPTX 97 kb)

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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Fuyuhiko Motoi
    • 1
  • Yoshiaki Murakami
    • 2
  • Ken-ichi Okada
    • 3
  • Ippei Matsumoto
    • 4
  • Kenichiro Uemura
    • 2
  • Sohei Satoi
    • 5
  • Masayuki Sho
    • 6
  • Goro Honda
    • 7
  • Takumi Fukumoto
    • 8
  • Hiroaki Yanagimoto
    • 5
  • Shoichi Kinoshita
    • 6
  • Masanao Kurata
    • 7
  • Shuichi Aoki
    • 1
  • Masamichi Mizuma
    • 1
  • Hiroki Yamaue
    • 3
  • Michiaki Unno
    • 1
  • for the Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS)
  1. 1.Department of SurgeryTohoku University Graduate School of MedicineSendaiJapan
  2. 2.Department of Surgery, Institute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
  3. 3.Second Department of SurgeryWakayama Medical UniversityWakayamaJapan
  4. 4.Department of Surgery, Faculty of MedicineKindai UniversityOsaka-SayamaJapan
  5. 5.Department of SurgeryKansai Medical UniversityHirakataJapan
  6. 6.Department of SurgeryNara Medical UniversityKashiharaJapan
  7. 7.Department of SurgeryTokyo Metropolitan Cancer and Infectious Diseases Center, Komagome HospitalTokyoJapan
  8. 8.Division of Hepato-Biliary-Pancreatic Surgery, Department of SurgeryKobe University Graduate School of MedicineKobeJapan

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