Omiya Kojiro, Oba Atsushi, Sugiura Kota, Maekawa Aya, Mie Takafumi, Kobayashi Kosuke, Ono Yoshihiro, Sasaki Takashi, Ozaka Masato, Sasahira Naoki, Ito Hiromichi, Inoue Yosuke, Takahashi Yu
Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Hepatobiliary and Pancreatic Surgery, Institute of Science Tokyo, Tokyo, Japan.
Ann Surg Oncol. 2025 May 13. doi: 10.1245/s10434-025-17407-5.
While anatomical resectability guides pancreatic cancer treatment, carbohydrate antigen (19-9 (CA19-9) serves as a biological indicator of disease burden. Current guidelines suggest considering neoadjuvant chemotherapy (NAC) for cases with markedly elevated CA19-9, but specific threshold values and treatment strategies remain undefined. This retrospective study aimed to evaluate the efficacy of intensive NAC using gemcitabine plus nab-paclitaxel or fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) for anatomically resectable pancreatic cancer with elevated CA19-9 (> 500 U/mL).
We analyzed patients with anatomically resectable pancreatic cancer and CA19-9 > 500 U/mL treated between 2014 and 2022. Initial planned treatments were either 4-month intensive NAC followed by surgery (NAC group) or upfront surgery (UPS group). Survival outcomes were evaluated using retrospective intention-to-treat analysis.
Among 184 included patients, 46 received NAC and 138 underwent upfront surgery. The NAC group demonstrated significantly improved overall survival compared with the UPS group (median 52.7 vs. 22.7 months, P < 0.001). Resection rates were 89.1% and 76.1% in the NAC and UPS groups, respectively. Among resected cases, the NAC group achieved higher lymph node-negative resection rates (53.7% vs. 23.8%, P < 0.001) and better post-resection CA19-9 normalization rates (75.6% vs. 56.1%, P = 0.037). Survival benefits were maintained even in cases with CA19-9 > 2000 U/mL (median OS 52.7 vs. 18.9 months, P = 0.025).
CA19-9 > 500 U/mL serves as an effective indicator for implementing intensive NAC in anatomically resectable pancreatic cancer. This biomarker-based strategy effectively extracts the beneficial group from NAC, prolonging survival outcomes through better systemic disease control.
虽然解剖学可切除性指导胰腺癌的治疗，但糖类抗原19-9（CA19-9）可作为疾病负担的生物学指标。当前指南建议，对于CA19-9显著升高的病例考虑新辅助化疗（NAC），但具体阈值和治疗策略仍未明确。这项回顾性研究旨在评估使用吉西他滨联合纳米白蛋白结合型紫杉醇或氟尿嘧啶、伊立替康和奥沙利铂（FOLFIRINOX）进行强化NAC治疗解剖学可切除且CA19-9升高（>500 U/mL）的胰腺癌的疗效。
我们分析了2014年至2022年间接受治疗的解剖学可切除胰腺癌且CA19-9>500 U/mL的患者。初始计划治疗方案为4个月的强化NAC后行手术（NAC组）或直接手术（UPS组）。使用回顾性意向性分析评估生存结局。
在184例纳入患者中，46例接受了NAC，138例接受了直接手术。与UPS组相比，NAC组的总生存期显著改善（中位生存期52.7个月对22.7个月，P<0.001）。NAC组和UPS组的切除率分别为89.1%和76.1%。在切除病例中，NAC组实现了更高的淋巴结阴性切除率（53.7%对23.8%，P<0.001）和更好的切除后CA19-9正常化率（75.6%对56.1%，P=0.037）。即使在CA19-9>2000 U/mL的病例中，生存获益也得以维持（中位总生存期52.7个月对18.9个月，P=0.025）。
CA19-9>500 U/mL可作为在解剖学可切除胰腺癌中实施强化NAC的有效指标。这种基于生物标志物的策略有效地从NAC中筛选出受益组，通过更好地控制全身疾病来延长生存结局。
