Serum CA 19-9 Response to Neoadjuvant Therapy is Associated with Outcome in Pancreatic Adenocarcinoma

Brian A. Boone, Jennifer Steve, Mazen S. Zenati, Melissa E. Hogg, Aatur D. Singhi, David L. Bartlett, Amer H. Zureikat, Nathan Bahary, Herbert J. Zeh

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Background: Baseline carbohydrate antigen 19-9 (CA 19-9) is a useful prognostic marker in pancreatic ductal adenocarcinoma (PDA); however, data on the significance of a change in CA 19-9 following neoadjuvant therapy are lacking.

Methods: All patients receiving neoadjuvant therapy for PDA from July 2010 to February 2013 were retrospectively reviewed. Resection rate, R0 resection rate, need for venous resection, and overall survival were correlated to CA 19-9 response. Fisher’s exact test, Kaplan–Meier survival analysis, and multivariate analysis using Cox regression were used.

Results: A total of 78 patients were studied (21 patients with resectable disease, 40 borderline resectable, and 17 with locally advanced disease). A variety of chemotherapies ± radiation were utilized during the study period. Overall, 56 patients (72 %) had a decrease in CA 19-9 of >50 % with neoadjuvant treatment. In borderline resectable patients, CA 19-9 response of >50 % predicted R0 resection (odds ratio 4.2; p = 0.05). In borderline resectable patients who had an increase in CA 19-9, none of five (0 %) underwent R0 resection compared with 80 % of the remaining cohort (p = 0.001). The complete pathologic response rate was 29 % in patients who had a CA 19-9 response of >90 % versus 0 % in the remaining patients (p < 0.001). A CA 19-9 response of >50 % resulted in improved overall survival (28.0 vs. 11.1 months; p < 0.0001) and was an independent predictor of survival (hazard ratio 0.26; 95 % CI 0.13–0.55; p < 0.0001).

Conclusions: CA 19-9 response to neoadjuvant therapy is associated with R0 resection rate, histopathologic response, and survival. Incorporation of this easily obtainable biomarker into future clinical trials may facilitate more rapid evaluation of novel regimens.

Original languageEnglish (US)
Pages (from-to)4351-4358
Number of pages8
JournalAnnals of Surgical Oncology
Volume21
Issue number13
DOIs
StatePublished - Oct 31 2014
Externally publishedYes

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Neoadjuvant Therapy
Adenocarcinoma
Carbohydrates
Antigens
Serum
Survival
Survival Analysis
Multivariate Analysis
Biomarkers
Odds Ratio
Clinical Trials

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Serum CA 19-9 Response to Neoadjuvant Therapy is Associated with Outcome in Pancreatic Adenocarcinoma. / Boone, Brian A.; Steve, Jennifer; Zenati, Mazen S.; Hogg, Melissa E.; Singhi, Aatur D.; Bartlett, David L.; Zureikat, Amer H.; Bahary, Nathan; Zeh, Herbert J.

In: Annals of Surgical Oncology, Vol. 21, No. 13, 31.10.2014, p. 4351-4358.

Research output: Contribution to journalArticle

Boone, BA, Steve, J, Zenati, MS, Hogg, ME, Singhi, AD, Bartlett, DL, Zureikat, AH, Bahary, N & Zeh, HJ 2014, 'Serum CA 19-9 Response to Neoadjuvant Therapy is Associated with Outcome in Pancreatic Adenocarcinoma', Annals of Surgical Oncology, vol. 21, no. 13, pp. 4351-4358. https://doi.org/10.1245/s10434-014-3842-z
Boone, Brian A. ; Steve, Jennifer ; Zenati, Mazen S. ; Hogg, Melissa E. ; Singhi, Aatur D. ; Bartlett, David L. ; Zureikat, Amer H. ; Bahary, Nathan ; Zeh, Herbert J. / Serum CA 19-9 Response to Neoadjuvant Therapy is Associated with Outcome in Pancreatic Adenocarcinoma. In: Annals of Surgical Oncology. 2014 ; Vol. 21, No. 13. pp. 4351-4358.
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title = "Serum CA 19-9 Response to Neoadjuvant Therapy is Associated with Outcome in Pancreatic Adenocarcinoma",
abstract = "Background: Baseline carbohydrate antigen 19-9 (CA 19-9) is a useful prognostic marker in pancreatic ductal adenocarcinoma (PDA); however, data on the significance of a change in CA 19-9 following neoadjuvant therapy are lacking.Methods: All patients receiving neoadjuvant therapy for PDA from July 2010 to February 2013 were retrospectively reviewed. Resection rate, R0 resection rate, need for venous resection, and overall survival were correlated to CA 19-9 response. Fisher’s exact test, Kaplan–Meier survival analysis, and multivariate analysis using Cox regression were used.Results: A total of 78 patients were studied (21 patients with resectable disease, 40 borderline resectable, and 17 with locally advanced disease). A variety of chemotherapies ± radiation were utilized during the study period. Overall, 56 patients (72 {\%}) had a decrease in CA 19-9 of >50 {\%} with neoadjuvant treatment. In borderline resectable patients, CA 19-9 response of >50 {\%} predicted R0 resection (odds ratio 4.2; p = 0.05). In borderline resectable patients who had an increase in CA 19-9, none of five (0 {\%}) underwent R0 resection compared with 80 {\%} of the remaining cohort (p = 0.001). The complete pathologic response rate was 29 {\%} in patients who had a CA 19-9 response of >90 {\%} versus 0 {\%} in the remaining patients (p < 0.001). A CA 19-9 response of >50 {\%} resulted in improved overall survival (28.0 vs. 11.1 months; p < 0.0001) and was an independent predictor of survival (hazard ratio 0.26; 95 {\%} CI 0.13–0.55; p < 0.0001).Conclusions: CA 19-9 response to neoadjuvant therapy is associated with R0 resection rate, histopathologic response, and survival. Incorporation of this easily obtainable biomarker into future clinical trials may facilitate more rapid evaluation of novel regimens.",
author = "Boone, {Brian A.} and Jennifer Steve and Zenati, {Mazen S.} and Hogg, {Melissa E.} and Singhi, {Aatur D.} and Bartlett, {David L.} and Zureikat, {Amer H.} and Nathan Bahary and Zeh, {Herbert J.}",
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T1 - Serum CA 19-9 Response to Neoadjuvant Therapy is Associated with Outcome in Pancreatic Adenocarcinoma

AU - Boone, Brian A.

AU - Steve, Jennifer

AU - Zenati, Mazen S.

AU - Hogg, Melissa E.

AU - Singhi, Aatur D.

AU - Bartlett, David L.

AU - Zureikat, Amer H.

AU - Bahary, Nathan

AU - Zeh, Herbert J.

PY - 2014/10/31

Y1 - 2014/10/31

N2 - Background: Baseline carbohydrate antigen 19-9 (CA 19-9) is a useful prognostic marker in pancreatic ductal adenocarcinoma (PDA); however, data on the significance of a change in CA 19-9 following neoadjuvant therapy are lacking.Methods: All patients receiving neoadjuvant therapy for PDA from July 2010 to February 2013 were retrospectively reviewed. Resection rate, R0 resection rate, need for venous resection, and overall survival were correlated to CA 19-9 response. Fisher’s exact test, Kaplan–Meier survival analysis, and multivariate analysis using Cox regression were used.Results: A total of 78 patients were studied (21 patients with resectable disease, 40 borderline resectable, and 17 with locally advanced disease). A variety of chemotherapies ± radiation were utilized during the study period. Overall, 56 patients (72 %) had a decrease in CA 19-9 of >50 % with neoadjuvant treatment. In borderline resectable patients, CA 19-9 response of >50 % predicted R0 resection (odds ratio 4.2; p = 0.05). In borderline resectable patients who had an increase in CA 19-9, none of five (0 %) underwent R0 resection compared with 80 % of the remaining cohort (p = 0.001). The complete pathologic response rate was 29 % in patients who had a CA 19-9 response of >90 % versus 0 % in the remaining patients (p < 0.001). A CA 19-9 response of >50 % resulted in improved overall survival (28.0 vs. 11.1 months; p < 0.0001) and was an independent predictor of survival (hazard ratio 0.26; 95 % CI 0.13–0.55; p < 0.0001).Conclusions: CA 19-9 response to neoadjuvant therapy is associated with R0 resection rate, histopathologic response, and survival. Incorporation of this easily obtainable biomarker into future clinical trials may facilitate more rapid evaluation of novel regimens.

AB - Background: Baseline carbohydrate antigen 19-9 (CA 19-9) is a useful prognostic marker in pancreatic ductal adenocarcinoma (PDA); however, data on the significance of a change in CA 19-9 following neoadjuvant therapy are lacking.Methods: All patients receiving neoadjuvant therapy for PDA from July 2010 to February 2013 were retrospectively reviewed. Resection rate, R0 resection rate, need for venous resection, and overall survival were correlated to CA 19-9 response. Fisher’s exact test, Kaplan–Meier survival analysis, and multivariate analysis using Cox regression were used.Results: A total of 78 patients were studied (21 patients with resectable disease, 40 borderline resectable, and 17 with locally advanced disease). A variety of chemotherapies ± radiation were utilized during the study period. Overall, 56 patients (72 %) had a decrease in CA 19-9 of >50 % with neoadjuvant treatment. In borderline resectable patients, CA 19-9 response of >50 % predicted R0 resection (odds ratio 4.2; p = 0.05). In borderline resectable patients who had an increase in CA 19-9, none of five (0 %) underwent R0 resection compared with 80 % of the remaining cohort (p = 0.001). The complete pathologic response rate was 29 % in patients who had a CA 19-9 response of >90 % versus 0 % in the remaining patients (p < 0.001). A CA 19-9 response of >50 % resulted in improved overall survival (28.0 vs. 11.1 months; p < 0.0001) and was an independent predictor of survival (hazard ratio 0.26; 95 % CI 0.13–0.55; p < 0.0001).Conclusions: CA 19-9 response to neoadjuvant therapy is associated with R0 resection rate, histopathologic response, and survival. Incorporation of this easily obtainable biomarker into future clinical trials may facilitate more rapid evaluation of novel regimens.

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