新辅助治疗后血清碳水化合物抗原 19-9 水平降低可预测胰腺腺癌患者的预后更好：一项 240 例患者的多中心病例对照研究。

Decreased serum carbohydrate antigen 19-9 levels after neoadjuvant therapy predict a better prognosis for patients with pancreatic adenocarcinoma: a multicenter case-control study of 240 patients.

机构信息

Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan.

Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan.

出版信息

BMC Cancer. 2019 Mar 21;19(1):252. doi: 10.1186/s12885-019-5460-4.

BACKGROUND

Carbohydrate antigen (CA) 19-9 levels after resection are considered to predict prognosis; however, the significance of decreased CA19-9 levels after neoadjuvant therapy has not been clarified. This study aimed to define the prognostic significance of decreased CA19-9 levels after neoadjuvant therapy in patients with pancreatic adenocarcinoma.

METHODS

Between 2001 and 2012, 240 consecutive patients received neoadjuvant therapy and subsequent resection at seven high-volume institutions in Japan. These patients were divided into three groups: Normal group (no elevation [≤37 U/ml] before and after neoadjuvant therapy), Responder group (elevated levels [> 37 U/ml] before neoadjuvant therapy but decreased levels [≤37 U/ml] afterwards), and Non-responder group (elevated levels [> 37 U/ml] after neoadjuvant therapy). Analyses of overall survival and recurrence patterns were performed. Uni- and multivariate analyses were performed to clarify the clinicopathological factors influencing overall survival. The initial metastasis sites were also evaluated in these groups.

RESULTS

The Responder group received a better prognosis than the Non-responder group (3-year overall survival: 50.6 and 41.6%, respectively, P = 0.026), but the prognosis was comparable to the Normal group (3-year overall survival: 54.2%, P = 0.934). According to the analysis of the receiver operating characteristic curve, the CA19-9 cut-off level defined as no elevation after neoadjuvant therapy was ≤103 U/ml. The multivariate analysis revealed that a CA19-9 level ≤ 103 U/ml, (P = 0.010, hazard ratio: 1.711; 95% confidence interval: 1.133-2.639), tumor size ≤27 mm (P = 0.040, 1.517; (1.018-2.278)), a lack of lymph node metastasis (P = 0.002, 1.905; (1.276-2.875)), and R0 status (P = 0.045, 1.659; 1.012-2.627) were significant predictors of overall survival. Moreover, the Responder group showed a lower risk of hepatic recurrence (18%) compared to the Non-responder group (31%), though no significant difference in loco-regional, peritoneal or other distant recurrence were observed between groups (P = 0.058, P = 0.700 and P = 0.350, respectively).

CONCLUSIONS

Decreased CA19-9 levels after neoadjuvant therapy predicts a better prognosis, with low incidence of hepatic recurrence after surgery.

背景

切除术后的碳水化合物抗原（CA）19-9 水平被认为可预测预后；然而，新辅助治疗后 CA19-9 水平降低的意义尚未阐明。本研究旨在定义胰腺腺癌患者新辅助治疗后 CA19-9 水平降低的预后意义。

方法

2001 年至 2012 年间，7 家日本高容量机构的 240 例连续患者接受了新辅助治疗和随后的切除术。这些患者分为三组：正常组（新辅助治疗前后无升高[≤37 U/ml]）、应答组（新辅助治疗前升高[>37 U/ml]但治疗后降低[≤37 U/ml]）和非应答组（新辅助治疗后升高[>37 U/ml]）。进行了总体生存和复发模式分析。进行了单变量和多变量分析，以阐明影响总体生存的临床病理因素。还评估了这些组的初始转移部位。

结果

应答组的预后优于非应答组（3 年总生存率分别为 50.6%和 41.6%，P=0.026），但与正常组的预后相当（3 年总生存率：54.2%，P=0.934）。根据受试者工作特征曲线分析，定义为新辅助治疗后无升高的 CA19-9 截断值为≤103 U/ml。多变量分析显示，CA19-9 水平≤103 U/ml（P=0.010，风险比：1.711；95%置信区间：1.133-2.639）、肿瘤大小≤27mm（P=0.040，1.517；（1.018-2.278））、无淋巴结转移（P=0.002，1.905；（1.276-2.875））和 R0 状态（P=0.045，1.659；（1.012-2.627）是总体生存的显著预测因子。此外，与非应答组（31%）相比，应答组的肝复发风险较低（18%），但两组间局部区域、腹膜或其他远处复发无显著差异（P=0.058，P=0.700，P=0.350）。