Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled Analysis
BACKGROUND: Presurgical carbohydrate antigen 19-9 (CA19-9) level predicts overall survival (OS) in resected pancreatic adenocarcinoma (PaC). The aim of this pooled analysis was to evaluate if presurgical CA19-9 level can also predict local control (LC) and distant metastasis-free survival (DMFS). ME...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2019-01-01
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| Series: | Translational Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1936523318303607 |
| _version_ | 1811265333798895616 |
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| author | Gian Carlo Mattiucci Alessio G. Morganti Francesco Cellini Milly Buwenge Riccardo Casadei Andrea Farioli Sergio Alfieri Alessandra Arcelli Federica Bertini Felipe A. Calvo Silvia Cammelli Lorenzo Fuccio Lucia Giaccherini Alessandra Guido Joseph M. Herman Gabriella Macchia Bert W. Maidment, III Robert C. Miller Francesco Minni William F. Regine Michele Reni Stefano Partelli Massimo Falconi Vincenzo Valentini |
| author_facet | Gian Carlo Mattiucci Alessio G. Morganti Francesco Cellini Milly Buwenge Riccardo Casadei Andrea Farioli Sergio Alfieri Alessandra Arcelli Federica Bertini Felipe A. Calvo Silvia Cammelli Lorenzo Fuccio Lucia Giaccherini Alessandra Guido Joseph M. Herman Gabriella Macchia Bert W. Maidment, III Robert C. Miller Francesco Minni William F. Regine Michele Reni Stefano Partelli Massimo Falconi Vincenzo Valentini |
| author_sort | Gian Carlo Mattiucci |
| collection | DOAJ |
| description | BACKGROUND: Presurgical carbohydrate antigen 19-9 (CA19-9) level predicts overall survival (OS) in resected pancreatic adenocarcinoma (PaC). The aim of this pooled analysis was to evaluate if presurgical CA19-9 level can also predict local control (LC) and distant metastasis-free survival (DMFS). METHODS: Seven hundred patients with PaC from eight institutions who underwent surgical resection ± adjuvant treatment between 2000 and 2014 were analyzed. Patients were divided based on four presurgical CA19-9 level cutoffs (5, 37, 100, 353 U/ml). Weibull regression model to identify independent predictors of OS on 404 patients with complete information was fitted. RESULTS: Median follow-up was 17 months (range: 2-225 months). Univariate analysis showed a better prognosis in pT1-2, pN0, diameter <30 mm, or grade 1 tumors and in patients undergoing R0 resection, distal pancreatectomy, or adjuvant chemotherapy and with lower CA19-9 levels. Five-year OS, LC, and DMFS were as follows: CA19-9 <5.0: 5.7%, 47.2%, 17.0%; CA19-9 5.1-37.0: 37.9%, 63.3%, 46.0%; CA19-9 37.1-100.0: 27.1%, 59.4%, 39.0%; CA19-9 100.1-353.0: 17.4%, 43.4%, 26.7%; CA19-9 >353.1: 10.9%, 50.2%, and 23.4%, respectively. At multivariate analysis, CA19-9 >100 and <353 level (P=.002), CA19-9 ≥353.1 (P<.001) level, G3 tumor (P=.002), and tumor diameter >30 mm (P<.001) correlated with worse OS. Patients treated with postoperative chemoradiation doses >50.0 Gy showed improved OS (P<.001). CONCLUSION: Presurgical CA19-9 predicts both OS and pattern of failure. Therefore, CA19-9 should be included in predictive models in order to customize treatments based on prognostic factors. Moreover, future studies should stratify patients according to presurgical CA19-9 level. |
| first_indexed | 2024-04-12T20:20:49Z |
| format | Article |
| id | doaj.art-b0b688abf8054b4f9e7d7dbc6d57b74a |
| institution | Directory Open Access Journal |
| issn | 1936-5233 |
| language | English |
| last_indexed | 2024-04-12T20:20:49Z |
| publishDate | 2019-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Translational Oncology |
| spelling | doaj.art-b0b688abf8054b4f9e7d7dbc6d57b74a2022-12-22T03:18:00ZengElsevierTranslational Oncology1936-52332019-01-0112117Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled AnalysisGian Carlo Mattiucci0Alessio G. Morganti1Francesco Cellini2Milly Buwenge3Riccardo Casadei4Andrea Farioli5Sergio Alfieri6Alessandra Arcelli7Federica Bertini8Felipe A. Calvo9Silvia Cammelli10Lorenzo Fuccio11Lucia Giaccherini12Alessandra Guido13Joseph M. Herman14Gabriella Macchia15Bert W. Maidment, III16Robert C. Miller17Francesco Minni18William F. Regine19Michele Reni20Stefano Partelli21Massimo Falconi22Vincenzo Valentini23UOC Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Roma, ItaliaRadiation Oncology Center, Dept of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, ItalyUOC Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Roma, Italia; Address all correspondence to: Francesco Cellini, MD, Radiation Oncology Department Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Roma, Italy.Radiation Oncology Center, Dept of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, ItalyDepartment of Medical and Surgical Sciences, University of Bologna, Bologna, ItalyDepartment of Medical and Surgical Sciences, University of Bologna, Bologna, ItalyIstituto di Clinica Chirurgica, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Roma, ItaliaRadiation Oncology Center, Dept of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, ItalyRadiation Oncology Center, Dept of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, ItalyDepartment of Oncology, Hospital General Universitario Gregorio Marañón, Complutense University, Madrid, SpainRadiation Oncology Center, Dept of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, ItalyDepartment of Medical and Surgical Sciences, University of Bologna, Bologna, ItalyRadiation Oncology Center, Dept of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, ItalyRadiation Oncology Center, Dept of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, ItalyDepartment of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Mariland, USARadiotherapy Unit, General Oncology Unit, Fondazione Giovanni Paolo II, Campobasso, ItalyDepartment of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USADepartment of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USADepartment of Medical and Surgical Sciences, University of Bologna, Bologna, ItalyDepartment of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland, USADepartment of Medical Oncology, IRCCS Ospedale S. Raffaele, Milan, ItalyDepartment of Medical Oncology, IRCCS Ospedale S. Raffaele, Milan, ItalyPancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital, University ''Vita e Salute'', Milan, ItalyUOC Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica Sacro Cuore, Roma, ItaliaBACKGROUND: Presurgical carbohydrate antigen 19-9 (CA19-9) level predicts overall survival (OS) in resected pancreatic adenocarcinoma (PaC). The aim of this pooled analysis was to evaluate if presurgical CA19-9 level can also predict local control (LC) and distant metastasis-free survival (DMFS). METHODS: Seven hundred patients with PaC from eight institutions who underwent surgical resection ± adjuvant treatment between 2000 and 2014 were analyzed. Patients were divided based on four presurgical CA19-9 level cutoffs (5, 37, 100, 353 U/ml). Weibull regression model to identify independent predictors of OS on 404 patients with complete information was fitted. RESULTS: Median follow-up was 17 months (range: 2-225 months). Univariate analysis showed a better prognosis in pT1-2, pN0, diameter <30 mm, or grade 1 tumors and in patients undergoing R0 resection, distal pancreatectomy, or adjuvant chemotherapy and with lower CA19-9 levels. Five-year OS, LC, and DMFS were as follows: CA19-9 <5.0: 5.7%, 47.2%, 17.0%; CA19-9 5.1-37.0: 37.9%, 63.3%, 46.0%; CA19-9 37.1-100.0: 27.1%, 59.4%, 39.0%; CA19-9 100.1-353.0: 17.4%, 43.4%, 26.7%; CA19-9 >353.1: 10.9%, 50.2%, and 23.4%, respectively. At multivariate analysis, CA19-9 >100 and <353 level (P=.002), CA19-9 ≥353.1 (P<.001) level, G3 tumor (P=.002), and tumor diameter >30 mm (P<.001) correlated with worse OS. Patients treated with postoperative chemoradiation doses >50.0 Gy showed improved OS (P<.001). CONCLUSION: Presurgical CA19-9 predicts both OS and pattern of failure. Therefore, CA19-9 should be included in predictive models in order to customize treatments based on prognostic factors. Moreover, future studies should stratify patients according to presurgical CA19-9 level.http://www.sciencedirect.com/science/article/pii/S1936523318303607 |
| spellingShingle | Gian Carlo Mattiucci Alessio G. Morganti Francesco Cellini Milly Buwenge Riccardo Casadei Andrea Farioli Sergio Alfieri Alessandra Arcelli Federica Bertini Felipe A. Calvo Silvia Cammelli Lorenzo Fuccio Lucia Giaccherini Alessandra Guido Joseph M. Herman Gabriella Macchia Bert W. Maidment, III Robert C. Miller Francesco Minni William F. Regine Michele Reni Stefano Partelli Massimo Falconi Vincenzo Valentini Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled Analysis Translational Oncology |
| title | Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled Analysis |
| title_full | Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled Analysis |
| title_fullStr | Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled Analysis |
| title_full_unstemmed | Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled Analysis |
| title_short | Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled Analysis |
| title_sort | prognostic impact of presurgical ca19 9 level in pancreatic adenocarcinoma a pooled analysis |
| url | http://www.sciencedirect.com/science/article/pii/S1936523318303607 |
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