Homma Yuki, Miyake Kentaro, Kikuchi Yutaro, Yabushita Yasuhiro, Matsuyama Ryusei, Endo Itaru
Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama City, Japan.
World J Oncol. 2025 Jun;16(3):269-275. doi: 10.14740/wjon2563. Epub 2025 Jun 14.
Carbohydrate antigen 19-9 (CA19-9) is widely used to assess treatment response and monitor recurrence alongside imaging. However, the criteria for determining resectability after completion of neoadjuvant therapy (NAT) remain poorly defined. Therefore, this study aimed to investigate the indications for surgical resection as a prognostic factor following NAT with gemcitabine and S-1 (NATGS).
In this retrospective cohort study, we examined patients who underwent curative pancreatic resection following NATGS at our institution between April 2018 and December 2023. After excluding six patients who did not undergo pancreatectomy, the remaining 50 patients were included in the study. Univariate and multivariate analyses were conducted to identify factors potentially associated with survival after NATGS.
Post-NATGS CA19-9 levels (< 100 U/mL) were identified as a significant prognostic factor for disease-free survival (DFS) in both univariate and multivariate analyses (hazard ratio (HR) = 11.72251, P < 0.001). For overall survival (OS), both CA19-9 levels (< 100 U/mL) and Duke pancreatic monoclonal antigen type 2 (DUPAN-2) levels (< 150 U/mL) were significant prognostic factors in univariate and multivariate analyses (CA19-9: HR = 17.88, P = 0.002; DUPAN-2: HR = 2.667, P = 0.03). The median DFS was 24.1 months in the low CA19-9 group compared with the 7.1 months in the high CA19-9 group (P = 0.002). The median OS in the low CA19-9 group was not reached, whereas it was 14.7 months in the high CA19-9 group (P = 0.001).
The CA19-9 cut-off value is clinically significant for patients undergoing NATGS regimens. Patients with pre-operative CA19-9 levels ≥ 100 U/mL may benefit from extended GS treatment or a switch to a more potent regimen rather than proceeding directly to surgical resection.
糖类抗原19-9（CA19-9）被广泛用于评估治疗反应以及与影像学检查一起监测复发情况。然而，新辅助治疗（NAT）完成后确定可切除性的标准仍未明确界定。因此，本研究旨在探讨吉西他滨联合S-1新辅助治疗（NATGS）后手术切除作为预后因素的指征。
在这项回顾性队列研究中，我们对2018年4月至2023年12月期间在本机构接受NATGS后行根治性胰腺切除术的患者进行了检查。在排除6例未接受胰腺切除术的患者后，其余50例患者纳入研究。进行单因素和多因素分析以确定NATGS后可能与生存相关的因素。
在单因素和多因素分析中，NATGS后CA19-9水平（<100 U/mL）均被确定为无病生存期（DFS）的显著预后因素（风险比（HR）=11.72251，P<0.001）。对于总生存期（OS），CA19-9水平（<100 U/mL）和杜克胰腺单克隆抗原2型（DUPAN-2）水平（<150 U/mL）在单因素和多因素分析中均为显著预后因素（CA19-9：HR=17.88，P=0.002；DUPAN-2：HR=2.667，P=0.03）。低CA19-9组的中位DFS为24.1个月，而高CA19-9组为7.1个月（P=0.002）。低CA19-9组的中位OS未达到，而高CA19-9组为14.7个月（P=0.001）。
CA19-9临界值对接受NATGS方案的患者具有临床意义。术前CA19-9水平≥100 U/mL的患者可能从延长的GS治疗或改用更有效的方案中获益，而不是直接进行手术切除。
