Prognostic significance of preoperative and postoperative CA 19-9 normalization in pancreatic adenocarcinoma treated with neoadjuvant therapy or surgery first

Background Normal(ization) of serum carbohydrate 19-9 (CA19-9) before/after surgery has not been compared in patients with pancreatic adenocarcinoma (PDAC) treated with neoadjuvant therapy (NT) versus surgery-first (SF). Methods Characteristics for patients with PDAC who underwent resection from July 2011 to October 2018 were collected. Patients with pre-/postoperative CA19-9, bilirubin <2 mg/dL, and initial CA19-9 > 1 U/ml were included. Overall survival (OS) and recurrence-free survival (RFS) were compared by pre-/postoperative CA19-9. Results In patients receiving NT, normal pre/postoperative CA19-9 (NTnl/nl) was associated with median RFS and OS (26 and 77mo), followed by those who normalized after surgery (NTabnl/nl 16 and 44mo). For SF patients, normal pre-/postoperative CA19-9 (SFnl/nl) was associated with median RFS and OS (115 and not estimable mo), followed by those who normalized after resection (SFabnl/nl 18 and 49mo). Groups NTabnl/abnl and SFabnl/abnl with elevated CA19-9 both before and after resection had the worst median RFS and OS durations. Conclusions While a normal(ized) postoperative CA19-9 may result in similar survival as preoperative normal(ization), postoperative normalization failed to occur in nearly 30% of SF patients. NT should be considered in patients presenting with elevated CA19-9. If considering SF, ideal patients may include those with normal CA19-9 at presentation.

Automated summary

This study compared the normalization of serum carbohydrate 19-9 (CA19-9) levels before and after surgery in patients with pancreatic adenocarcinoma (PDAC) who underwent neoadjuvant therapy (NT) versus surgery-first (SF). The results showed that normal pre/postoperative CA19-9 was associated with better recurrence-free survival (RFS) and overall survival (OS). Nearly 30% of SF patients failed to achieve postoperative CA19-9 normalization. NT should be considered for patients with elevated CA19-9 levels, and ideal SF patients may have normal CA19-9 levels at presentation.