Background

Preoperative/Neoadjuvant treatment (NT) is increasingly used in unresectable pancreatic cancer (PDAC). However, ∼40% of patients cannot be resected after NT and reliable preoperative response evaluation is currently lacking. We investigated CA 19-9 levels and their dynamics during NT for prediction of resectability and survival.

Methods

We screened our institution's database for patients who underwent exploration or resection after NT with gemcitabine-based therapy (GEM) or FOLFIRINOX (FOL). Pre- and post-NT CA 19-9, resection rate and survival were analyzed.

Results

Of 318 patients 165 (51.9%) were resected and 153 (48.1%) received exploration. In the FOL group (n = 103; 32.4%), a post-NT CA 19-9 cutoff at 91.8 U/ml had a sensitivity of 75.0% and a specificity of 76.9% for completing resection with an AUC of 0.783 in the ROC analysis (95% CI: 0.692–0.874; p < 0.001. PPV: 84.2%, NPV: 65.2%). Resected patients above the cutoff did not benefit from resection. Post-NT CA 19-9 <91.8 U/ml (OR 11.63, p < 0.001) and CA 19-9 ratio of <0.4 (OR 5.77, p = 0.001) were independent predictors for resectability in FOL patients.

Discussion

CA 19-9 levels after neoadjuvant treatment with FOLFIRINOX predict resectability and survival of PDAC more accurately than dynamic values and should be incorporated into response evaluation and surgical decision-making.

中文翻译：

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胰腺癌的诱导化疗：CA 19-9可能预测可切除性和生存率。

背景

术前/新辅助治疗（NT）越来越多地用于不可切除的胰腺癌（PDAC）。但是，约有40％的患者在NT后无法切除，目前尚缺乏可靠的术前反应评估。我们调查了NT期间CA 19-9的水平及其动态，以预测可切除性和存活率。

方法

我们筛选了我们机构的数据库，以了解在吉西他滨为基础的治疗（GEM）或FOLFIRINOX（FOL）后在NT下进行探查或切除的患者。分析NT CA 19-9之前和之后，切除率和存活率。

结果

在318例患者中，有165例（51.9％）被切除，而153例（48.1％）接受了探查。在FOL组中（n  = 103; 32.4％），NT CA 19-9切除后的91.8 U / ml临界值在ROC中完成切除的敏感性为75.0％，特异性为76.9％，ROC为0.783分析（95％CI：0.692-0.874；p  < 0.001。PPV ：84.2％，NPV：65.2％）。超过临界值的切除患者不能从切除术中受益。NT后CA 19-9 <91.8 U / ml（OR 11.63，p  <0.001）和CA 19-9比率<0.4（OR 5.77，p  = 0.001）是FOL患者可切除性的独立预测因子。

讨论

FOLFIRINOX新辅助治疗后的CA 19-9水平比动态值更准确地预测PDAC的可切除性和存活率，应将其纳入反应评估和手术决策中。