Added value of CA19-9 response in predicting resectability of locally advanced pancreatic cancer following induction chemotherapy

Veldhuisen, Eran van; Vogel, Jantien A.; Klompmaker, Sjors; Busch, Olivier R.; Laarhoven, Hanneke W. M. van; Lienden, Krijn P. van; Wilmink, Johanna W.; Marsman, Hendrik A.; Besselink, Marc G.

doi:10.1016/j.hpb.2018.01.001

Cited by 74 publications

(103 citation statements)

References 19 publications

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“…Although in our cohort limited patients with LAPC underwent neoadjuvant chemotherapy, a small difference in CEA and CA19-9 was seen, which suggests that besides tumour anatomy, tumour biology has to be taken into account in the treatment of PDAC patients. Furthermore, it has been suggested that a decrease (>30%) of CA19-9 level in LAPC patients during the course of neoadjuvant therapy, resulted in improved resection rates during surgical exploration, which confirmed the relevance of tumour biology in patient selection for surgery (van Veldhuisen et al 2018).…”

Section: Discussionmentioning

confidence: 80%

Elevated CEA and CA19-9 serum levels independently predict advanced pancreatic cancer at diagnosis

et al. 2020

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Purpose: It is suggested that tumour markers carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) could be used to predict the stage of pancreatic cancer. However, optimal cut-off values for CEA and CA19-9 are disputable. This study aimed to assess the value of CEA and CA19-9 serum levels at diagnosis of pancreatic ductal adenocarcinoma (PDAC) as predictors for the advanced stage of PDAC in patients discussed at pancreatic multidisciplinary team (MDT) meetings. Methods: Patients with suspected PDAC discussed at MDT meetings from 2013 to 2017 were reviewed, in order to determine optimal cut-off values of both CEA and CA19-9. Results: In total, 375 patients were included. Optimal cut-off values for predicting advanced PDAC were 7.0 ng/ml for CEA and 305.0 U/ml for CA19-9, resulting in positive predictive values of 83.3%, 73.6%, and 91.4% for CEA, CA19-9 and combined, respectively. Both tumour markers were independent predictors of advanced PDAC, demonstrated by an odds ratio of 4.21 (95% CI:1.85-9.56; p ¼ 0.001) for CEA and 2.58 for CA19-9 (95% CI:1.30-5.14; p ¼ 0.007).Conclusions: CEA appears to be a more robust predictor of advanced PDAC than CA19-9. Implementing CEA and CA19-9 serum levels during MDT meetings as an additional tool for establishing tumour resectability is worthwhile for tailored diagnostics. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 80%

Elevated CEA and CA19-9 serum levels independently predict advanced pancreatic cancer at diagnosis

et al. 2020

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“…Postoperative normalization of serum CA19-9 after pancreatic resection for pancreatic cancer correlates with an improved prognosis compared to an increase or lower but still elevated value (4). CA19-9 can help predict which patients are suitable for resection after induction therapy for locally advanced pancreatic cancer (5). Pre-and post-treatment CA19-9 can also be used to evaluate the effect of chemotherapy on pancreatic cancer (6).…”

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confidence: 99%

The Value of CA19-9 After Irreversible Electroporation for Pancreatic Cancer

et al. 2019

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Background/Aim: Carbohydrate antigen 19-9 (CA19-9) is a tumor marker for pancreatic cancer. Irreversible electroporation (IRE) is an experimental treatment modality for pancreatic cancer. The aim of this study was to evaluate whether percutaneous IRE lowers the CA19-9 level in pancreatic cancer and whether this correlates with improved overall survival. Patients and Methods: Seventy-one patients with locally advanced pancreatic cancer or local recurrence after resection were treated. Patients with missing data, metastatic disease and normal serum CA19-9 before IRE were excluded. This left 35 cases for analysis. Results: The median CA19-9 did not decrease in the cohort after IRE treatment (282 U/ml before versus 315 U/ml after; p=0.80). The 25th percentile of patients with the best CA19-9 response had improved overall survival compared to the 25th percentile with the worst response (mean 13.1 versus 8.1 months, respectively; p=0.01). Conclusion: IRE did not lower the level of CA19-9 in pancreatic cancer cases. However, a response in CA19-9 was correlated with improved survival.

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“…This may lead to missed opportunities to resect. Previous prospective series showed only a 40% sensitivity of a CT-based RECIST partial response for resectability in patients with LAPC following induction chemotherapy 14 and no correlation with tumor size decrease with R0 resection. 6 In addition, vascular involvement and thus resectability is not accurately measured by CT-scan after FOLFIRINOX therapy.…”

Section: Discussionmentioning

confidence: 87%

“…19 Biomarkers such as CA19-9 and plasma microRNAs have been previously described to be useful in selecting patients for surgery after induction chemotherapy and should be used in addition to current imaging modalities. 14,20,21 The results of this study should be interpreted in light of several limitations. First, this was a non-blinded study, since the performing radiologist was aware of the outcomes of the restaging CT-scans.…”

Section: Discussionmentioning

confidence: 90%

Added value of intra-operative ultrasound to determine the resectability of locally advanced pancreatic cancer following FOLFIRINOX chemotherapy (IMAGE): a prospective multicenter study

Veldhuisen

Walma

Rijssen

et al. 2019

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Background: Determining the resectability of locally advanced pancreatic cancer (LAPC) after FOLFIRINOX chemotherapy is challenging because CT-scans cannot reliably assess vascular involvement. This study evaluates the added value of intra-operative ultrasound (IOUS) in LAPC following FOLFIRINOX induction chemotherapy. Methods: Prospective multicenter study in patients with LAPC who underwent explorative laparotomy with IOUS after FOLFIRINOX chemotherapy. Resectability was defined according to the National Comprehensive Cancer Network guidelines. IOUS findings were compared with preoperative CT-scans and pathology results. Results: CT-staging in 38 patients with LAPC after FOLFIRINOX chemotherapy defined 22 patients LAPC, 15 borderline resectable and one resectable. IOUS defined 19 patients LAPC, 13 borderline resectable and six resectable. In 12/38 patients, IOUS changed the resectability status including five patients from borderline resectable to resectable and five patients from LAPC to borderline resectable. Two patients were upstaged from borderline resectable to LAPC. Tumor diameters were significantly smaller upon IOUS (31.7 ± 9.5 mm versus 37.1 ± 10.0 mm, p = 0.001) and resectability varied significantly (p = 0.043). Ultimately, 20 patients underwent resection of whom 14 were evaluated as (borderline) resectable on CT-scan, and 17 on IOUS. Discussion: This prospective study demonstrates that IOUS may change the resectability status up to a third of patients with LAPC following FOLFIRINOX chemotherapy.

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Added value of CA19-9 response in predicting resectability of locally advanced pancreatic cancer following induction chemotherapy

Abstract: Adding CA19-9 response after induction chemotherapy seems useful in determining which patients with RECIST non-progressive LAPC should undergo exploratory surgery.

Cited by 74 publications

References 19 publications

Elevated CEA and CA19-9 serum levels independently predict advanced pancreatic cancer at diagnosis

Elevated CEA and CA19-9 serum levels independently predict advanced pancreatic cancer at diagnosis

The Value of CA19-9 After Irreversible Electroporation for Pancreatic Cancer

Added value of intra-operative ultrasound to determine the resectability of locally advanced pancreatic cancer following FOLFIRINOX chemotherapy (IMAGE): a prospective multicenter study

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