The prognostic value of CA19-9 response after neoadjuvant therapy in patients with pancreatic cancer: a systematic review and pooled analysis

The Prognostic Significance of Novel Pancreas Cancer Prognostic Index in Unresectable Locally Advanced Pancreas Cancers Treated with Definitive Concurrent Chemoradiotherapy

“…The advancing literature has established the prognostic value of CA 19-9 in LAPAC patients managed with chemotherapy or C-CRT plus/minus surgery. [16][17][18][19][20][21][22][23] Although different CA 19-9 cutoffs were utilized, results of past investigations confirmed the significant association between higher CA 19-9 levels and reduced survival results in PAC patients. [19][20][21][22][23] Like our study, the researchers of the aforementioned landmark Charité Onkologie 001 (CONKO-001) and RTOG 97-04 randomized trials chose the CA 19-9 ≤ 90 U/mL as the cutoff level for prognostic stratification of such patients.…”

“…[16][17][18][19][20][21][22][23] Although different CA 19-9 cutoffs were utilized, results of past investigations confirmed the significant association between higher CA 19-9 levels and reduced survival results in PAC patients. [19][20][21][22][23] Like our study, the researchers of the aforementioned landmark Charité Onkologie 001 (CONKO-001) and RTOG 97-04 randomized trials chose the CA 19-9 ≤ 90 U/mL as the cutoff level for prognostic stratification of such patients. 16,17 Authenticating the CA 19-9 as a prognostic factor, Choi et al reported that the pretreatment higher CA 19-9 levels were associated with significantly reduced survival outcomes in their three-tiered nomogram consolidating the SUVmax, radiotherapy dose, and CA 19-9 in a gathering of 426 LAPAC patients undergoing C-CRT.…”

“…3,7,9,10,[31][32][33]35 Similarly, CA 19-9 has been extensively studied for its prognostic significance in PAC patients undergoing various oncological treatments, with proven efficacy for accurate prediction of pretreatment tumor stage and resectability status, response to therapy, PFS, and OS outcomes, despite various cutoffs being used in these researches. [16][17][18][19][20][21][22][23] Surprisingly, establishing rational grounds for the present investigation, the blend of these two potent biomarkers had never been tested before for its prognostic significance in unresectable LAPAC patients who underwent exclusive C-CRT albeit SIRI was first formulated for PAC patients and the CA 19-9 demonstrates its chief utility in PACs.…”

“…[16][17][18] Concerning the prognostic value of CA 19-9, several investigations have found a significant association between the diminished survival results and higher CA 19-9 levels, even though variable cutoffs were adopted in these studies. [19][20][21][22][23] In this respect, the researchers of the benchmark Charité Onkologie 001 (CONKO-001) randomized trial used the CA 19-9 ≤ 90 U/mL threshold level for eligibility in their study, which compared adjuvant chemotherapy with gemcitabine against observation in 368 patients undergoing curative-intent resection of PACs. 16 Later the validity of this cutoff was established by the results of the Radiation Therapy Oncology Group (RTOG) randomized Phase III trial 9704 comparing the use of either continuous infusion 5-fluorouracil (5-FU) or gemcitabine before and after concurrent CRT with 5-FU in patients with resected PACs.…”

Paradigm shift for defining the resectability of pancreatic cancer

“…To obtain objective response criteria for NAT, the Response Evaluation Criteria in Solid Tumor (RECIST) as morphological criteria [ 27 ], various CA19-9 cutoff values as biological criteria [ 2 ], and the European Organization for Research and Treatment of Cancer (EORTC)/PET Response Criteria in Solid Tumors (PERCIST) criteria as metabolic criteria [ 28 , 29 ] can be used. Regarding CA19-9, some have argued for the need to identify patient groups who would benefit from surgery based on CA19-9 response levels after NAT, while others have agreed that stable disease on imaging is sufficient if there is any decrease in CA19-9 levels [ 30 - 34 ]. However, the target value varies from CA19-9 levels normalized to 80–400 U/mL or a 30%–80% reduction compared to the initial status [ 2 ].…”