Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.
Cancer Center Amsterdam, Amsterdam, the Netherlands.
Ann Surg Oncol. 2024 Mar;31(3):1919-1932. doi: 10.1245/s10434-023-14680-0. Epub 2024 Jan 3.
About 25% of patients with localized pancreatic adenocarcinoma have non-elevated serum carbohydrate antigen (CA) 19-9 levels at baseline, hampering evaluation of response to preoperative treatment. Serum carcinoembryonic antigen (CEA) is a potential alternative.
This retrospective cohort study from five referral centers included consecutive patients with localized pancreatic adenocarcinoma (2012-2019), treated with one or more cycles of (m)FOLFIRINOX, and non-elevated CA19-9 levels (i.e., < 37 U/mL) at baseline. Cox regression analyses were performed to assess prognostic factors for overall survival (OS), including CEA level at baseline, restaging, and dynamics.
Overall, 277 patients were included in this study. CEA at baseline was elevated (≥5 ng/mL) in 53 patients (33%) and normalized following preoperative therapy in 14 patients (26%). In patients with elevated CEA at baseline, median OS in patients with CEA normalization following preoperative therapy was 33 months versus 19 months in patients without CEA normalization (p = 0.088). At time of baseline, only elevated CEA was independently associated with (worse) OS (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.04-1.98). At time of restaging, elevated CEA at baseline was still the only independent predictor for (worse) OS (HR 1.44, 95% CI 1.04-1.98), whereas elevated CEA at restaging (HR 1.16, 95% CI 0.77-1.77) was not.
Serum CEA was elevated in one-third of patients with localized pancreatic adenocarcinoma having non-elevated CA19-9 at baseline. At both time of baseline and time of restaging, elevated serum CEA measured at baseline was the only predictor for (worse) OS. Therefore, serum CEA may be a useful tool for decision making at both initial staging and time of restaging in patients with non-elevated CA19-9.
约 25%的局限性胰腺腺癌患者在基线时血清糖类抗原（CA）19-9 水平不升高，这阻碍了对术前治疗反应的评估。癌胚抗原（CEA）是一种潜在的替代物。
本研究为来自五个转诊中心的回顾性队列研究，纳入了 2012 年至 2019 年间接受（m）FOLFIRINOX 一个或多个周期治疗且基线时 CA19-9 水平不升高（即<37 U/mL）的局限性胰腺腺癌患者。进行 Cox 回归分析以评估总生存（OS）的预后因素，包括基线、重新分期和动态时的 CEA 水平。
本研究共纳入 277 例患者。53 例（33%）患者基线时 CEA 升高（≥5ng/mL），14 例（26%）患者在术前治疗后 CEA 正常化。在基线时 CEA 升高的患者中，CEA 正常化的患者中位 OS 为 33 个月，而 CEA 未正常化的患者中位 OS 为 19 个月（p=0.088）。在基线时，只有升高的 CEA 与（更差）OS 独立相关（风险比 [HR] 1.44，95%置信区间 [CI] 1.04-1.98）。在重新分期时，基线时升高的 CEA 仍然是（更差）OS 的唯一独立预测因素（HR 1.44，95% CI 1.04-1.98），而重新分期时升高的 CEA（HR 1.16，95% CI 0.77-1.77）则不是。
在基线时 CA19-9 不升高的局限性胰腺腺癌患者中，有三分之一的患者血清 CEA 升高。在基线时和重新分期时，基线时升高的血清 CEA 是唯一预测（更差）OS 的因素。因此，在 CA19-9 不升高的患者中，血清 CEA 可能是初始分期和重新分期时决策的有用工具。
