Department of Surgery, Osaka International Cancer Institute, Japan.
Department of Surgery, Osaka International Cancer Institute, Japan.
Pancreatology. 2020 Jul;20(5):919-928. doi: 10.1016/j.pan.2020.05.020. Epub 2020 Jun 6.
Biological factors are emphasized in borderline resectable pancreatic cancer (BRPC), and CA19-9 is an important factor for biological borderline resectability (b-BR). The aim of this study was to investigate the cut-off value of CA19-9 for biological borderline resectability and "biological downstaging" in chemoradiation therapy (CRT) for pancreatic cancer (PC).
A total of 407 patients with anatomically resectable PC (a-R) and BRPC (a-BR) received preoperative gemcitabine-based CRT. The b-BR was determined, according to the CA19-9 value prior to preoperative CRT (pre-CA19-9), as the subgroup of a-R cases in which the survival was comparable with that in a-BR cases. "Biological downstaging" was determined based on prognostic analyses regarding the CA19-9 value after preoperative CRT (post-CA19-9) in association with the survival of R cases (a-R cases without the b-BR factor).
The 5-year survival of a-R patients with pre-CA19-9 > 120 U/mL was comparable with that of a-BR patients (44% vs 34%, p = 0.082). The survival of b-BR patients with post-CRT CA19-9 ≤ 37 U/mL (normalized) was comparably favorable with that of R patients (56% vs 65%, p = 0.369). The incidence of distant recurrence was higher in b-BR patients without post-CA19-9 normalization than in those with post-CA19-9 normalization (70% vs 50%, p = 0.003), while the incidence of local recurrence was comparable between these two groups (12% vs 13%, p = 0.986).
Biological BRPC was determined to be an anatomically resectable disease with pre-CA19-9 > 120 U/mL, and post-CA19-9 normalization indicated "biological downstaging" in b-BR in the preoperative CRT strategy.
生物学因素在交界可切除胰腺癌（BRPC）中受到重视，CA19-9 是生物学交界可切除性（b-BR）的重要因素。本研究旨在探讨 CA19-9 对胰腺癌（PC）放化疗（CRT）的生物学交界可切除性和“生物学降期”的临界值。
共 407 例解剖可切除 PC（a-R）和 BRPC（a-BR）患者接受术前吉西他滨为基础的 CRT。根据术前 CRT 前的 CA19-9 值（pre-CA19-9）确定 b-BR，将 a-R 病例分为与 a-BR 病例生存相当的亚组。根据术前 CRT 后 CA19-9 值（post-CA19-9）与 R 病例（无 b-BR 因素的 a-R 病例）生存的预后分析确定“生物学降期”。
pre-CA19-9 > 120 U/mL 的 a-R 患者的 5 年生存率与 a-BR 患者相当（44% vs 34%，p = 0.082）。post-CRT CA19-9 ≤ 37 U/mL（正常化）的 b-BR 患者的生存与 R 患者相当（56% vs 65%，p = 0.369）。post-CA19-9 未正常化的 b-BR 患者远处复发的发生率高于 post-CA19-9 正常化的患者（70% vs 50%，p = 0.003），而两组局部复发的发生率相当（12% vs 13%，p = 0.986）。
pre-CA19-9 > 120 U/mL 的 BRPC 被确定为具有生物学可切除性的疾病，post-CA19-9 正常化表示 b-BR 在术前 CRT 策略中的“生物学降期”。
