Duration of Reduced CA19-9 Levels Is a Better Prognostic Factor Than Its Rate of Reduction for Unresectable Locally Advanced Pancreatic Cancer

Abstract

A decrease in carbohydrate antigen (CA) 19-9 levels has been proposed as a prognostic marker for survival and recurrence in patients with pancreatic cancer. We evaluated the association between duration of reduced CA 19-9 levels during 6 months after treatment and long-term survival for 79 patients with unresectable locally advanced pancreatic cancer (LAPC). We calculated the differences between pretreatment and monthly CA19-9 levels. We categorized 71 patients with decreases in CA19-9 levels into three groups based on the duration of these reduced levels (>2, >3, and >4 months). The cut-off level for long-term (more than 2 years) survival was identified as a 44% reduction from the baseline, using a ROC curve. A reduction duration >2 months was not associated with overall survival (p = 0.1), while >3 months was significantly associated with survival (p =.04). In multivariate analysis, a reduction duration >3 months predicted a good long-term prognosis (odds ratio = 5.75; 95% confidence interval = 1.47–22.36; p < 0.01). In patients with unresectable LAPC, the duration of reduced CA19-9 levels for more than 3 months, rather than the rate of reduction in CA19-9 levels, during 6 months after treatment was significantly associated with good prognosis.

Clinicopathological Characteristics and Prognosis of Diffuse Large B-Cell Lymphoma in Relation to CA-125 and CA 19-9 Expression

“…A previous study found a link between serum CA 19-9 level and PS score 1 in patients with unresectable pancreatic cancer, which is similar to our findings. 38 Moreover, other studies reported that patients with higher preoperative CA 19-9 levels had a lower chance of survival, whereas patients with lower post-operative CA 19-9 levels had a higher chance of survival. As a result, they concluded that PS, response rate, and decreased CA 19-9 serum levels were significant prognostic factors.…”

Survival outcomes of conversion surgery for metastatic pancreatic ductal adenocarcinoma after neoadjuvant therapy

“…[30] During NAT, either a decrease or normalization of CA19-9 levels contributes to improved survival time after curative resection. [31,32] In addition, a novel CA19-9 response type combining dynamic changes and normalization of CA19-9 levels during NAT has recently been proposed by Newhook et al [33] This response type correlates with post-resection survival in patients with PDAC and could inform treatment decisions based on real-time dynamics. [33] Adjuvant therapy is the standard of care for resected PDAC based on level 1 evidence and has yielded encouraging results in ongoing clinical trials.…”

Clinical Efficacy and Safety of Traditional Medicine Preparations Combined With Chemotherapy for Advanced Pancreatic Cancer: A Systematic Review and Meta-Analysis

“…The level of CA19-9 has been associated with tumor size ( 81 ), stage, and survival ( 82 ), as it is often used for diagnosis, prognosis and monitoring of patients with pancreatic cancer ( 83 , 84 ). It has been observed that particularly, if the duration of the decline in CA19-9 levels was greater than 3 months during the 6 months period after initiation of the treatment, it could be significantly related to the good prognosis of APC ( 85 ). The previous studies have also shown that CA19-9 can effectively accelerate the process of pancreatic cancer by causing protein modification ( 86 ), binding to E-selectin, as well as by promoting angiogenesis, and is therefore considered as a potential target and an important research area for the treatment of APC ( 87 ).…”