CA19-9 Normalization During Pre-operative Treatment Predicts Longer Survival for Patients with Locally Progressed Pancreatic Cancer.
Compared to the widely adopted 2-4 months of pre-operative therapy for patients with borderline resectable (BR) or locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC), our institution tends to administer a longer duration before considering surgical resection. Using this unique approach, the aim of this study was to determine pre-operative variables associated with survival.



Records from patients with BR/LA PDAC who underwent attempt at surgical resection from 1992-2014 were reviewed.



After a median duration of 6 months of pre-operative treatment, 109 patients with BR/LA PDAC (BR 63, LA 46) were explored; 93 (85.3 %) underwent pancreatectomy. Those who received at least 6 months of pre-operative treatment had longer median overall survival (OS) than those who received less (52.8 vs. 32.1 months, P = 0.044). On multivariate analysis, pre-operative treatment duration was the strongest predictor of survival (hazard ratio (HR) 4.79, P = 0.043). However, OS was similar in those whose CA19-9 normalized regardless of whether they received more or less than 6 months of chemotherapy (71.4 vs. 101.8 months, P = 0.930).



Pre-operative CA19-9 decline can guide treatment duration in patients with BR/LA PDAC. We endorse 6 months of therapy except in those patients whose values normalize, where surgery can be considered after a shorter course.
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, 90502, USA.
Jennifer L
JL
Williams
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
Brian E
BE
Kadera
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
Andrew H
AH
Nguyen
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
V Raman
VR
Muthusamy
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
Zev A
ZA
Wainberg
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
O Joe
OJ
Hines
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
Howard A
HA
Reber
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA. tdonahue@mednet.ucla.edu.|Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, 72-215 CHS, Box 956904, Los Angeles, CA, 90095, USA. tdonahue@mednet.ucla.edu.
Timothy R
TR
Donahue
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood*; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods / Q000401:mortality*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D013997:Time Factors
D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D005472:Fluorouracil
CA 19-9 antigen; Neoadjuvant therapy; Pancreatic ductal adenocarcinoma