Department of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Medical Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
Ann Surg Oncol. 2018 Nov;25(12):3483-3491. doi: 10.1245/s10434-018-6521-7. Epub 2018 May 21.
Serum carbohydrate antigen 19-9 (CA19-9) correlates with response to therapy and overall survival (OS) for patients with pancreatic ductal adenocarcinoma (PDAC). This study aimed to define the chronologic relationship between CA19-9 elevation and radiographic recurrence to develop a model that can predict the risk of recurrence (RFS) and prognosis during interval surveillance for patients with resected PDAC.
A retrospective review examined patients undergoing surgery for pancreatic adenocarcinoma from January 2010 to May 2016. Their CA19-9 levels were classified at diagnosis, after surgery, and at 6-month surveillance intervals. Recurrence was defined by radiographic evidence. The CA19-9 levels were correlated with RFS and OS at every time point using multivariate analysis.
The study examined 525 patients. Five patterns of CA19-9 were identified: normal ("nonsecretors," 18.5%), always elevated, and high at diagnosis but normal after resection involving three patterns with varied behavior during surveillance. These five patterns had implications for RFS and OS. When elevation of CA19-9, as assessed at 6-month intervals, was analyzed relative to detection of radiographic disease, CA19-9 had poor positive predictive value (average, 35%) but high negative predictive value (average, 92%) for radiographic recurrence. Conditional RFS showed that CA19-9 elevation did not equal radiographic recurrence but predicted subsequent RFS. Additionally, conditional OS showed that CA19-9 elevation alone was predictive at each time point.
This study showed that CA19-9 patterns beyond the post-resection period predict RFS and OS. High CA19-9 frequently is discordant with recurrence on imaging and may precede it by more than 6 months. At each surveillance interval, CA19-9 is predictive of prognosis, which may help in counseling patients and could be used to direct protocols of salvage chemotherapy.
血清碳水化合物抗原 19-9（CA19-9）与胰腺导管腺癌（PDAC）患者的治疗反应和总生存期（OS）相关。本研究旨在定义 CA19-9 升高与影像学复发之间的时间关系，以建立一种能够预测接受 PDAC 切除术后患者在间隔期监测时复发风险（RFS）和预后的模型。
回顾性分析 2010 年 1 月至 2016 年 5 月接受胰腺腺癌手术的患者。在诊断时、手术后和 6 个月的监测间隔期对他们的 CA19-9 水平进行分类。通过影像学证据定义复发。使用多变量分析在每个时间点将 CA19-9 水平与 RFS 和 OS 相关联。
该研究共检查了 525 例患者。确定了 CA19-9 的五种模式：正常（“非分泌者”，18.5%）、始终升高以及诊断时升高但切除后正常，这三种模式在监测期间具有不同的行为。这五种模式对 RFS 和 OS 有影响。当以 6 个月的间隔期评估 CA19-9 的升高时，相对于影像学疾病的检测，CA19-9 对影像学复发的阳性预测值（平均为 35%）较低，但阴性预测值（平均为 92%）较高。条件 RFS 显示，CA19-9 的升高不等同于影像学复发，但可预测随后的 RFS。此外，条件 OS 显示 CA19-9 升高在每个时间点都是预测因素。
本研究表明，切除后时期之外的 CA19-9 模式可预测 RFS 和 OS。CA19-9 升高通常与影像学上的复发不一致，并且可能比影像学上的复发早 6 个月以上。在每个监测间隔期，CA19-9 都可预测预后，这有助于对患者进行咨询，并可用于指导挽救性化疗方案。
