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Serum CA 19-9 as a marker of resectability and survival in patients with potentially resectable pancreatic cancer treated with neoadjuvant chemoradiation.

Publication ,  Journal Article
Katz, MHG; Varadhachary, GR; Fleming, JB; Wolff, RA; Lee, JE; Pisters, PWT; Vauthey, J-N; Abdalla, EK; Sun, CC; Wang, H; Crane, CH; Lee, JH ...
Published in: Ann Surg Oncol
July 2010

PURPOSE: The role of carbohydrate antigen (CA) 19-9 in the evaluation of patients with resectable pancreatic cancer treated with neoadjuvant therapy prior to planned surgical resection is unknown. We evaluated CA 19-9 as a marker of therapeutic response, completion of therapy, and survival in patients enrolled on two recently reported clinical trials. PATIENTS AND METHODS: We analyzed patients with radiographically resectable adenocarcinoma of the head/uncinate process treated on two phase II trials of neoadjuvant chemoradiation. Patients without evidence of disease progression following chemoradiation underwent pancreaticoduodenectomy (PD). CA 19-9 was evaluated in patients with a normal bilirubin level. RESULTS: We enrolled 174 patients, and 119 (68%) completed all therapy including PD. Pretreatment CA 19-9 <37 U/ml had a positive predictive value (PPV) for completing PD of 86% but a negative predictive value (NPV) of 33%. Among patients without evidence of disease at last follow-up, the highest pretreatment CA 19-9 was 1,125 U/ml. Restaging CA 19-9 <61 U/ml had a PPV of 93% and a NPV of 28% for completing PD among resectable patients. The area under the receiver-operating characteristics curve of pretreatment and restaging CA 19-9 levels for completing PD was 0.59 and 0.74, respectively. We identified no association between change in CA 19-9 and histopathologic response (P = 0.74). CONCLUSIONS: Although the PPV of CA 19-9 for completing neoadjuvant therapy and undergoing PD was high, its clinical utility was compromised by a low NPV. Decision-making for patients with resectable PC should remain based on clinical assessment and radiographic staging.

Duke Scholars

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

July 2010

Volume

17

Issue

7

Start / End Page

1794 / 1801

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Retrospective Studies
  • Radiotherapy, Adjuvant
  • Radiotherapy Dosage
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Oncology & Carcinogenesis
  • Neoadjuvant Therapy
  • Middle Aged
 

Citation

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Katz, M. H. G., Varadhachary, G. R., Fleming, J. B., Wolff, R. A., Lee, J. E., Pisters, P. W. T., … Evans, D. B. (2010). Serum CA 19-9 as a marker of resectability and survival in patients with potentially resectable pancreatic cancer treated with neoadjuvant chemoradiation. Ann Surg Oncol, 17(7), 1794–1801. https://doi.org/10.1245/s10434-010-0943-1
Katz, Matthew H. G., Gauri R. Varadhachary, Jason B. Fleming, Robert A. Wolff, Jeffrey E. Lee, Peter W. T. Pisters, Jean-Nicolas Vauthey, et al. “Serum CA 19-9 as a marker of resectability and survival in patients with potentially resectable pancreatic cancer treated with neoadjuvant chemoradiation.Ann Surg Oncol 17, no. 7 (July 2010): 1794–1801. https://doi.org/10.1245/s10434-010-0943-1.
Katz MHG, Varadhachary GR, Fleming JB, Wolff RA, Lee JE, Pisters PWT, et al. Serum CA 19-9 as a marker of resectability and survival in patients with potentially resectable pancreatic cancer treated with neoadjuvant chemoradiation. Ann Surg Oncol. 2010 Jul;17(7):1794–801.
Katz, Matthew H. G., et al. “Serum CA 19-9 as a marker of resectability and survival in patients with potentially resectable pancreatic cancer treated with neoadjuvant chemoradiation.Ann Surg Oncol, vol. 17, no. 7, July 2010, pp. 1794–801. Pubmed, doi:10.1245/s10434-010-0943-1.
Katz MHG, Varadhachary GR, Fleming JB, Wolff RA, Lee JE, Pisters PWT, Vauthey J-N, Abdalla EK, Sun CC, Wang H, Crane CH, Lee JH, Tamm EP, Abbruzzese JL, Evans DB. Serum CA 19-9 as a marker of resectability and survival in patients with potentially resectable pancreatic cancer treated with neoadjuvant chemoradiation. Ann Surg Oncol. 2010 Jul;17(7):1794–1801.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

July 2010

Volume

17

Issue

7

Start / End Page

1794 / 1801

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Retrospective Studies
  • Radiotherapy, Adjuvant
  • Radiotherapy Dosage
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Oncology & Carcinogenesis
  • Neoadjuvant Therapy
  • Middle Aged