title: Serum carbohydrate antigen 19-9 represents a marker of response to neoadjuvant therapy in patients with borderline resectable pancreatic cancer.
abstract: OBJECTIVE
  The purpose of this study was to determine the relationship between carbohydrate antigen (CA) 19-9 levels and outcome in patients with borderline resectable pancreatic cancer treated with neoadjuvant therapy (NT).
  
  
  METHODS
  This study included all patients with borderline resectable pancreatic cancer, a serum CA 19-9 level of ≥40 U/ml and bilirubin of ≤2 mg/dl, in whom NT was initiated at one institution between 2001 and 2010. The study evaluated the associations between pre- and post-NT CA 19-9, resection and overall survival.
  
  
  RESULTS
  Among 141 eligible patients, CA 19-9 declined during NT in 116. Following NT, 84 of 141 (60%) patients underwent resection. For post-NT resection, the positive predictive value of a decline and the negative predictive value of an increase in CA 19-9 were 70% and 88%, respectively. The normalization of CA 19-9 (post-NT <40 U/ml) was associated with longer median overall survival among both non-resected (15 months versus 11 months; P = 0.022) and resected (38 months versus 26 months; P = 0.020) patients. Factors independently associated with shorter overall survival were no resection [hazard ratio (HR) 3.86, P < 0.001] and failure to normalize CA 19-9 (HR 2.13, P = 0.001).
  
  
  CONCLUSIONS
  The serum CA 19-9 level represents a dynamic preoperative marker of tumour biology and response to NT, and provides prognostic information in both non-resected and resected patients with borderline resectable pancreatic cancer.
authors.affiliation: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Ching-Wei D
authors.initials: CW
authors.lastname: Tzeng
authors.forename: Aparna
authors.initials: A
authors.lastname: Balachandran
authors.forename: Mediha
authors.initials: M
authors.lastname: Ahmad
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Sunil
authors.initials: S
authors.lastname: Krishnan
authors.forename: Huamin
authors.initials: H
authors.lastname: Wang
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Crane
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolff
authors.forename: Gauri R
authors.initials: GR
authors.lastname: Varadhachary
authors.forename: Peter W T
authors.initials: PW
authors.lastname: Pisters
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Aloia
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Jason B
authors.initials: JB
authors.lastname: Fleming
authors.forename: Matthew H G
authors.initials: MH
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000097:blood / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018395:CA-19-9 Antigen; D001663:Bilirubin