ASO Author Reflections: Carcinoembryonic Antigen as a Predictor of Failure to Reach Surgery in Patients with Borderline Resectable Pancreatic Cancer Undergoing Neoadjuvant Therapy.

Borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) presents a therapeutic challenge, balancing the benefits of neoadjuvant therapy (NT) against the risk of missing the opportunity for cure by upfront surgery. In this retrospective study, we evaluated real-world outcomes in patients with BR-PDAC undergoing NT and identified elevated baseline carcinoembryonic antigen (CEA) as an independent predictor of failure to reach surgery, primarily due to local tumor progression. Our findings suggest that CEA may serve as a practical biomarker to guide treatment selection between NT and upfront surgery.