title: Pre-treatment carbohydrate antigen 19-9 does not predict the response to neoadjuvant therapy in patients with localized pancreatic cancer.
abstract: BACKGROUND
  The prognostic value of CA19-9 in patients with pancreatic cancer (PC) treated with neoadjuvant therapy has not been well described.
  
  
  METHODS
  Pre-treatment CA19-9 levels (with concomitant normal bilirubin level) in patients with localized PC were categorized as normal (≤35), low (36-200), moderate (201-1000), or high (>1000). Post-treatment CA19-9 was measured after neoadjuvant therapy, prior to surgery.
  
  
  RESULTS
  Pre-treatment CA19-9 levels were evaluable in 235 patients, levels were normal in 60 (25%) patients, low in 78 (33%) patients, moderate in 69 (29%) and high in 28 (12%). After neoadjuvant therapy, post-treatment CA19-9 normalized (≤ 35) in 40 (51%) of the patients in the low group, 14 (21%) of the moderate and 5 (19%) of the high group (P < 0.001). Of the 235 patients, 168 (71%) completed all intended therapy including a pancreatectomy; 44 (73%), 62 (79%), 46 (67%) and 16 (57%) of the normal, low, moderate and high groups (P = 0.10). Among these 168 patients, the median overall survival was 38.4, 43.6, 44.7, 27.2 and 26.4 months for normal, low, moderate and high CA19-9 groups (log rank P = 0.72). Among resected patients, an elevated pre-treatment CA19-9 was of little prognostic value; instead, it was the CA19-9 response to neoadjuvant therapy that was prognostic [hazard ratio (HR): 1.80, P = 0.02].
  
  
  CONCLUSIONS
  Among patients who completed neoadjuvant therapy and surgery, pre-treatment CA19-9 obtained at the time of diagnosis was not predictive of overall survival, but normalization of post-treatment CA19-9 in response to neoadjuvant therapy was highly prognostic.
authors.affiliation: Departments of Surgery, Pancreatic Cancer Program, The Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Aldakkak
authors.affiliation: Departments of Surgery, Pancreatic Cancer Program, The Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Christians
authors.affiliation: Departments of Surgery, Pancreatic Cancer Program, The Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Ashley N
authors.initials: AN
authors.lastname: Krepline
authors.affiliation: Departments of Medicine, Pancreatic Cancer Program, The Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Ben
authors.initials: B
authors.lastname: George
authors.affiliation: Departments of Medicine, Pancreatic Cancer Program, The Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Ritch
authors.affiliation: Departments of Radiation Oncology, Pancreatic Cancer Program, The Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Erickson
authors.affiliation: Departments of Surgery, Pancreatic Cancer Program, The Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Fabian M
authors.initials: FM
authors.lastname: Johnston
authors.affiliation: Departments of Surgery, Pancreatic Cancer Program, The Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.affiliation: Departments of Surgery, Pancreatic Cancer Program, The Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Tsai
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D000368:Aged; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; D014408:Biomarkers, Tumor; C578959:carbohydrate antigen 199, human