title: CA 19-9 response as an early indicator of the effectiveness of gemcitabine in patients with advanced pancreatic cancer.
abstract: BACKGROUND
  The CA 19-9 decline 8 weeks after gemcitabine administration has been shown to be a useful prognosticator of survival in patients with pancreatic cancer. We assessed the prognostic value of changes in CA 19-9 levels 4 weeks after treatment initiation on overall survival (OS) and time to progression (TTP).
  
  
  METHODS
  We evaluated 72 patients who received gemcitabine for advanced pancreatic cancer. The serum CA 19-9 level was measured routinely at baseline (CA 19-9_Pre) and after the first (4 weeks; CA 19-9_A1) and second (8 weeks; CA 19-9_A2) courses. CA 19-9 responses were categorized into quartiles using the proportional change in CA 19-9.
  
  
  RESULTS
  The rates of decrease in CA 19-9_A1 and CA 19-9_A2 were strongly correlated with each other (r = 0.8981, p < 0.0001). Multivariate analysis revealed that an early CA 19-9 response was prognostic of OS and TTP in addition to CA 19-9_Pre and performance status. Compared with the first quartile of an early CA 19-9 response, hazard ratios for the second, third and fourth quartiles were 0.91 (95% confidence interval, CI, 0.59-1.34), 0.71 (95% CI, 0.45-1.08), and 0.63 (95% CI, 0.41-0.94) for TTP, respectively (p for trend = 0.002), and 0.98 (95% CI, 0.61-1.49), 0.68 (95% CI, 0.40-1.08) and 0.79 (95% CI, 0.50-1.21) for OS (p for trend = 0.036).
  
  
  CONCLUSIONS
  CA 19-9 response after the first course of gemcitabine was a prognosticator of OS and TTP in patients with advanced pancreatic cancer.
authors.affiliation: Department of Gastroenterology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.forename: Takao
authors.initials: T
authors.lastname: Kawabe
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Takashi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yagioka
authors.forename: Yoko
authors.initials: Y
authors.lastname: Yashima
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kogure
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Arizumi
authors.forename: Osamu
authors.initials: O
authors.lastname: Togawa
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Ito
authors.forename: Saburo
authors.initials: S
authors.lastname: Matsubara
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirano
authors.forename: Naoki
authors.initials: N
authors.lastname: Sasahira
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsujino
authors.forename: Minoru
authors.initials: M
authors.lastname: Tada
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D003841:Deoxycytidine; D000093542:Gemcitabine