Induction chemotherapy in pancreatic cancer: CA 19-9 may predict resectability and survival

Heger, Ulrike; Sun, Hongyan; Hinz, Ulf; Klaiber, Ulla; Tanaka, Masayuki; Liu, Bing; Sachsenmaier, M; Springfeld, Christoph; Michalski, Christoph; Büchler, Markus W.; Hackert, Thilo

doi:10.1016/j.hpb.2019.06.012

Cited by 54 publications

(77 citation statements)

References 36 publications

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“…Seventeen articles reported a surgical indication for conversion surgery in patients with initial UR‐PDAC . From a review of the articles, surgical indication seemed to be classified into broad and strict criteria.…”

Section: Resultsmentioning

confidence: 99%

“…A full dose of FOLFIRINOX was the only predictive factor for resectability. In the Heidelberg group, Heger et al reported that a CA19‐9 level <91.8 and a CA19‐9 ratio <0.407 were independent predictors of resectability in 318 patients with UR‐PDAC. Tanaka et al conducted a retrospective study in 101 metastatic patients, and 43 patients underwent pancreatectomy combined with metastasectomy.…”

Section: Resultsmentioning

confidence: 99%

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Surgical indication for and desirable outcomes of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma

Satoi

Yamamoto

Yamaki

et al. 2019

Annals of Gastroent Surgery

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Aim of this review is to propose an acceptable surgical indication for conversion surgery in patients with initially unresectable (UR) pancreatic ductal adenocarcinoma (PDAC) by considering desirable outcomes, including resectability, overall survival (OS), and disease-free survival (DFS). A comprehensive literature search of PubMed was conducted through July 15, 2019. Eligible studies were those reporting on patients with UR-PDAC who underwent surgery. We excluded case reports with fewer than 10 patients, insufficient descriptions of survival data, and palliative surgery.When patients with UR-PDAC with no progression after chemo(radiation) therapy were offered surgical exploration, resectability and median survival time (MST) of those who underwent conversion surgery ranged from 20% to 69% (median, 52%) and from 19.5 to 33 months (median, 21.9 months), respectively. When conversion surgery was carried out in patients with expected margin-negative resection or with clinical response by Response Evaluation Criteria In Solid Tumors (RECIST), resectability and MST ranged from 18% to 27% (median, 20%) and from 21 to 35.3 months (median, 30 months), respectively. Among patients who underwent conversion surgery based on clinical response and decreased CA19-9 level after multimodal treatment, resectability and MST ranged from 2% to 24% (median, 4.1%) and from 24.1 to 64 months (median, 36 months), respectively. Decreased CA19-9 level was a predictor of resectability, OS and DFS by multivariate analysis. In conclusion, decision-making for conversion surgery based on clinical response and decreased CA19-9 level after multimodal treatment may be appropriate. With regard to desirable outcomes of OS and DFS, conversion surgery may provide improved survival for patients with initial UR-PDAC. K E Y W O R D Sconversion surgery, overall survival, resectability, surgical indication, unresectable pancreatic ductal adenocarcinoma | 7 SATOI eT Al.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Surgical indication for and desirable outcomes of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma

Satoi

Yamamoto

Yamaki

et al. 2019

Annals of Gastroent Surgery

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“…For that reason, identifying unresectable patients preoperatively is vital to avoid undesired surgery [32][33][34][35] . For this reason, the use of serum CA 19-9 levels pre-operatively has been extensively evaluated to determine resectability in pancreatic cancer patients [32,33,[36][37][38][39][40] .…”

Section: Advantages Of Serum Ca 19-9 Levels As a Biomarker For Definimentioning

confidence: 99%

“…Heger et al [40] investigated the dynamics of CA 19-9 levels during neoadjuvant treatment (NT) in order to predict resectability and survival. The authors noticed a significant correlation between the reduced levels of CA 19-9 with resectability and OS.…”

Section: Advantages Of Serum Ca 19-9 Levels As a Biomarker For Definimentioning

confidence: 99%

“…The authors noticed a significant correlation between the reduced levels of CA 19-9 with resectability and OS. Importantly, a significant difference in CA 19-9 levels was observed following the treatment with FOLFIRINOX (FOL) as patients treated with this regimen had a significantly higher resection rate compared to those treated by gemcitabine-based NT [40] . Furthermore, the combination of NT and FOL was found to be associated with a significantly improved survival rate among resected pancreatic cancer patients [40] .…”

Section: Advantages Of Serum Ca 19-9 Levels As a Biomarker For Definimentioning

confidence: 99%

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Exploiting the relevance of CA 19-9 in pancreatic cancer

Salleh¹,

Thyagarajan²,

Sahu³

2020

JCMT

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Pancreatic ductal adenocarcinoma (PDAC) is currently the fourth most common cause of cancer-related deaths in the United States. It has a poor prognosis and remains a difficulty to treat malignancy. Over the past several decades, significant efforts have been directed towards developing new approaches to enhance the efficacy of therapeutic regimens for PDAC treatment. In recent years, the measurement of serum carbohydrate antigen 19-9 (CA 19-9) has become one of the most validated and extensively used tumour biomarkers for PDAC. In particular, serum CA 19-9 levels have been explored as a validated tool to predict either the signs of disease progression or the response to treatment. However, despite its clinical relevance, the implications on diagnosis or accurately predicting tumour resectability, and monitoring disease symptoms in PDAC patients remains limited. This current review highlights the recent updates on the applicability of CA 19-9, its exploitation, and challenges in predicting the treatment efficacy and responses in PDAC patients.

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Essential updates 2018/2019: Current topics in the surgical treatment of pancreatic ductal adenocarcinoma

Ishido

Hakamada

Kimura

et al. 2020

Annals of Gastroent Surgery

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Pancreatic ductal adenocarcinoma (PDAC) is highly malignant. While cancers in other organs have shown clear improvements in 5‐year survival, the 5‐year survival rate of pancreatic cancer is approximately 10%. Early relapse and metastasis are not uncommon, making it difficult to achieve an acceptable prognosis even after complete surgical resection of the pancreas. Studies have been performed on various treatments to improve the prognosis of PDAC, and multidisciplinary approaches including non‐surgical treatments have led to gradual improvement. In the present literature review, we have described the significance of anatomical and biological resectability criteria, the concept of R0 resection in surgical treatment, the feasibility of minimally invasive surgery, the remarkable development of perioperative chemotherapy, the effectiveness of conversion surgery for unresectable PDAC, and ongoing challenges in PDAC treatment. We also provide an essential update on these subjects by focusing on recent trends and topics.

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Induction chemotherapy in pancreatic cancer: CA 19-9 may predict resectability and survival

Cited by 54 publications

References 36 publications

Surgical indication for and desirable outcomes of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma

Surgical indication for and desirable outcomes of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma

Exploiting the relevance of CA 19-9 in pancreatic cancer

Essential updates 2018/2019: Current topics in the surgical treatment of pancreatic ductal adenocarcinoma

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