Role of CA 19.9 in the Management of Resectable Pancreatic Cancer: State of the Art and Future Perspectives

Coppola, Alessandro; Vaccara, Vincenzo La; Farolfi, Tommaso; Fiore, Michele; Cammarata, Roberto; Ramella, Sara; Coppola, Roberto; Caputo, Damiano

doi:10.3390/biomedicines10092091

Cited by 12 publications

(10 citation statements)

References 47 publications

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“…Recurrence patterns are also related to the prognosis, as patients with metastatic disease localized to the lung have been shown to have a signi cantly longer survival than those with metastatic disease localized to the liver [15]. Serum CA19-9 is a crucial tumor marker for PDAC, and several reports have validated its clinical utility in the diagnosis and monitoring of disease progression [23], as well as in predicting early recurrence after surgery for PDAC. Previous studies identi ed preoperative CA19-9 as an important predictor for early recurrence either within 6 or 12 months for patient cohorts who underwent upfront surgery as well as those who received neoadjuvant chemoradiotherapy [16,17,19].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Early Recurrence in Patients with Pancreatic Ductal Adenocarcinoma who Underwent Curative Resection

Murakawa

Kawahara

Takahashi

et al. 2023

Preprint

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Background The present study evaluated the clinical characteristics and risk factors for early recurrence in pancreatic ductal adenocarcinoma (PDAC) patients who underwent curative resection, regardless of the use of neoadjuvant chemotherapy, to identify predictive factors associated with early recurrence and poor outcomes as well as to determine the optimal treatment strategy for patients at high risk of early recurrence after surgical resection.Methods Patients who underwent pancreatic resection for PDAC at our institution from 2013 to 2021 were included in this study. We investigated the clinicopathological features of patients in groups: those with recurrence within 6 months, recurrence between 6 and 12 months, and recurrence beyond 12 months or no recurrence. A logistic regression analysis identified covariates associated with early recurrence at 6 and 12 months.Results The study included 403 patients with a median follow-up of 25.7 months. Recurrence was observed in 279 patients, with 14.6% recurring within 6 months, 23.3% within 6–12 months, and 62% after 12 months or not at all. The preoperative CA19-9 level, modified Glasgow prognostic score (mGPS), and positive peritoneal cytology were significant risk factors for early recurrence within 6 months, while positive peritoneal cytology, lymph node metastasis, and the absence of adjuvant chemotherapy were significant risk factors for recurrence within 12 months. For patients who received preoperative chemotherapy or chemoradiotherapy, the preoperative CA19-9 level, mGPS, and positive peritoneal cytology were significant independent risk factors for early recurrence within 6 months, while positive peritoneal cytology, lymph node metastasis, and absence of adjuvant chemotherapy were significant independent risk factors for recurrence within 12 months. The study concluded that the overall survival after surgical resection for potentially resectable PDAC worsened according to the number of risk factors present in the patient.Conclusions We clarified that preoperative CA19-9, positive peritoneal cytology, and the lack of adjuvant chemotherapy were consistent predictors for early recurrence within 6 and 12 months. In addition, an increased number of risk factors affecting the patient was associated with a poorer overall survival after potentially curable resection. Calculating the number of risk factors for early recurrence may be an essential predictive factor when considering treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Early Recurrence in Patients with Pancreatic Ductal Adenocarcinoma who Underwent Curative Resection

Murakawa

Kawahara

Takahashi

et al. 2023

Preprint

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“…In addition, the preoperative levels of CA 19-9 are negatively associated with the overall survival, nodal involvement, and margin status positivity in resectable PC. However, some limitations impair the role of CA 19-9 in PDAC preoperative staging and management[ 74 ], including up to 50% of PDAC patients without CA 19-9 secretion.…”

Section: Diagnostic and Prognostic Markers For Pancreatic Cancermentioning

confidence: 99%

Clinical diagnosis and management of pancreatic cancer: Markers, molecular mechanisms, and treatment options

Zhang¹,

Liu²,

Yang³

2022

World J Gastroenterol

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Pancreatic cancer (PC) is the third-leading cause of cancer deaths. The overall 5-year survival rate of PC is 9%, and this rate for metastatic PC is below 3%. However, the PC-induced death cases will increase about 2-fold by 2060. Many factors such as genetic and environmental factors and metabolic diseases can drive PC development and progression. The most common type of PC in the clinic is pancreatic ductal adenocarcinoma, comprising approximately 90% of PC cases. Multiple pathogenic processes including but not limited to inflammation, fibrosis, angiogenesis, epithelial-mesenchymal transition, and proliferation of cancer stem cells are involved in the initiation and progression of PC. Early diagnosis is essential for curable therapy, for which a combined panel of serum markers is very helpful. Although some mono or combined therapies have been approved by the United States Food and Drug Administration for PC treatment, current therapies have not shown promising outcomes. Fortunately, the development of novel immunotherapies, such as oncolytic viruses-mediated treatments and chimeric antigen receptor-T cells, combined with therapies such as neoadjuvant therapy plus surgery, and advanced delivery systems of immunotherapy will improve therapeutic outcomes and combat drug resistance in PC patients. Herein, the pathogenesis, molecular signaling pathways, diagnostic markers, prognosis, and potential treatments in completed, ongoing, and recruiting clinical trials for PC were reviewed.

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“…Recently, a prospective multicenter phase 2 trial demonstrated promising results when gemcitabine plus nab-paclitaxel chemotherapy were administered before surgery[ 18 ]. Even though the data supporting the use of neoadjuvant therapies in resectable PDACs are more limited, this strategy is proposed in patients with “biological” borderline resectable tumors ( e.g., radiological resectable PDACs with elevated levels of Ca-199)[ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Hot topics in pancreatic cancer management

Caputo¹

2023

World J Gastrointest Surg

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Pancreatic ductal adenocarcinoma (PDAC) is a sneaky and lethal disease burdened by poor prognosis. PDAC is often detected too late to be successfully cured, and it has been estimated that it will be a leading cause of cancer-related deaths in the near future. During the last decade, multimodal treatments involving surgery, chemotherapy and radiotherapy have contributed to improving the prognosis of this disease; however, long-term results are still not satisfactory. Postoperative morbidity and mortality rates remain high, and systemic treatments are burdened by toxicity in both neoadjuvant and adjuvant settings. Advancements in technologies, targeted therapies, immunotherapy and PDAC microenvironment modulation strategies may represent useful potential weapons in the future. Nevertheless, in the fight against this dreadful disease, there is an urgent need for new, cheap and user-friendly tools for early detection. In this field, promising results have been found in nanotechnologies and “omics” analyses that search for new biomarkers to be used in primary and secondary prevention. However, there are many issues that need to be solved before considering these tools in daily clinical practice. This editorial reported the state of the art of pancreatic cancer management.

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Role of CA 19.9 in the Management of Resectable Pancreatic Cancer: State of the Art and Future Perspectives

Cited by 12 publications

References 47 publications

Risk Factors for Early Recurrence in Patients with Pancreatic Ductal Adenocarcinoma who Underwent Curative Resection

Risk Factors for Early Recurrence in Patients with Pancreatic Ductal Adenocarcinoma who Underwent Curative Resection

Clinical diagnosis and management of pancreatic cancer: Markers, molecular mechanisms, and treatment options

Hot topics in pancreatic cancer management

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