BACKGROUND Pancreatectomy offers only potential for cure but is only possible in a minority of patients. Even in those patients who receive adjuvant chemotherapy, majority of them succumb to death due to metastases. Radiation Therapy Oncology Group 9704 showed that post-surgery CA 19-9 levels are an important predictor of survival. European study group for pancreatic cancer-3 showed that completion of all 6 cycles of adjuvant chemotherapy was an independent prognostic factor. Any survival benefit of an intensified chemotherapy strategy has not been demonstrated in patients with persistently elevated CA 19-9 following surgery. The object of this study was to investigate any benefit of maintenance chemotherapy following adjuvant in these patients. METHODS Twenty patients with R0 surgery of pancreatic cancer who received adjuvant chemotherapy with post-surgery elevated CA 19-9 but no radiographic evidence of cancer was identified from 2005-2017. Either biopsy or positron emission tomography scan determined recurrence of cancer. Efficacy endpoints including overall survival and disease-free survival were assessed. RESULTS Maintenance and additional chemotherapeutic agents included 5-FU, capecitabine, platinum agents, irinotecan and nab-paclitaxel. CA 19-9 normalized in 3 patients while 22 persisted to be elevated or had further increase in the marker. Two patients underwent metastatectomy. Median disease-free survival was 14.5m (9-18), OS 29m (19-96) and OS rates were 80%, 50% at 1 and 2 years respectively. CONCLUSIONS We believe that the longer overall survival of our patients with elevated CA 19-9 post-surgery was due to maintenance and additional chemotherapy following planned 6-months of adjuvant therapy, close monitoring with monthly CA 19-9 and 3-monthly computed tomography scans. Our study also underlines importance of collecting pre-surgery CA 19-9 and complete staging including chest. Prospective study aiming to evaluate role of maintenance or intensified chemotherapy or targeted agents are indicated.

中文翻译：

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对术后胰腺癌患者术后 CA 19-9 升高的患者进行辅助化疗后维持化疗是否有生存益处？

背景胰腺切除术仅提供治愈的可能性，但仅在少数患者中是可能的。即使在那些接受辅助化疗的患者中，他们中的大多数也因转移而死亡。放射治疗肿瘤学组 9704 表明，术后 CA 19-9 水平是生存的重要预测指标。欧洲胰腺癌 3 研究组显示，完成所有 6 个周期的辅助化疗是一个独立的预后因素。在手术后 CA 19-9 持续升高的患者中，尚未证实强化化疗策略的任何生存益处。本研究的目的是调查这些患者在辅助化疗后维持化疗的任何益处。方法 2005-2017 年接受辅助化疗的 20 例胰腺癌 R0 手术患者术后 CA 19-9 升高，但未发现癌症的影像学证据。活检或正电子发射断层扫描确定癌症复发。评估了包括总生存期和无病生存期在内的疗效终点。结果 维持和其他化疗药物包括 5-FU、卡培他滨、铂类药物、伊立替康和白蛋白结合型紫杉醇。3 名患者的 CA 19-9 正常化，而 22 名患者的标志物持续升高或进一步升高。两名患者接受了转移瘤切除术。中位无病生存期为 14.5m (9-18)，OS 为 29m (19-96)，1 年和 2 年 OS 率分别为 80%、50%。结扫描。我们的研究还强调了收集术前 CA 19-9 和包括胸部在内的完整分期的重要性。前瞻性研究旨在评估维持或强化化疗或靶向药物的作用。