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Prognostic Impact of CA 19-9 on Outcome after Neoadjuvant Chemoradiation in Patients with Locally Advanced Pancreatic Cancer

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

To asses the impact of CA 19-9 and weight loss/gain on outcome after neoadjuvant chemoradiation (CRT) in patients with locally advanced pancreatic cancer (LAPC).

Methods

We analyzed 289 patients with LAPC treated with CRT for LAPC. All patients received concomitant chemotherapy parallel to radiotherapy and adjuvant treatments. CA 19-9 and body weight were collected as prognostic and predictive markers. All patients were included into a regular follow-up with reassessment of resectability.

Results

Median overall survival in all patients was 14 months. Actuarial overall survival was 37 % at 12 months, 12 % at 24 months, and 4 % at 36 months. Secondary resectability was achieved in 35 % of the patients. R0/R1 resection was significantly associated with increase in overall survival (p = 0.04). Intraoperative radiotherapy was applied in 50 patients, but it did not influence overall survival (p = 0.05). Pretreatment CA 19-9 significantly influenced overall survival using different cutoff values. With increase in CA 19-9 levels, the possibility of secondary surgical resection decreased from 46 % in patients with CA 19-9 levels below 90 U/ml to 31 % in the group with CA 19-9 levels higher than 269 U/ml.

Discussion

This large group of patients with LAPC treated with neoadjuvant CRT confirms that CA 19-9 and body weight are strong predictive and prognostic factors of outcome. In the future, individual patient factors should be taken into account to tailor treatment.

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Acknowledgment

We thank Sabine Kuhn and her team for excellent patient care. Supported in part by Klinische Forschergruppe Schwerionentherapie KFO 214.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, Germany

    Stephanie E. Combs MD, Daniel Habermehl MD, Jens Werner MD, Patrick Naumann MD & Jürgen Debus MD

  2. Department of Pathology, University Hospital of Heidelberg, Heidelberg, Germany

    Frank Bergmann MD & Jens Werner MD

  3. Department of Surgery, University Hospital of Heidelberg, Heidelberg, Germany

    Jens Werner MD & Markus W. Büchler MD

  4. National Center for Tumor Diseases, University Hospital of Heidelberg, Heidelberg, Germany

    Jens Werner MD & Dirk Jäger MD

  5. Department of Radiation Oncology, Technische Universität München (TUM), Munich, Germany

    Stephanie E. Combs MD & Kerstin A. Kessel PhD

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  1. Stephanie E. Combs MD
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Correspondence to Stephanie E. Combs MD.

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Combs, S.E., Habermehl, D., Kessel, K.A. et al. Prognostic Impact of CA 19-9 on Outcome after Neoadjuvant Chemoradiation in Patients with Locally Advanced Pancreatic Cancer. Ann Surg Oncol 21, 2801–2807 (2014). https://doi.org/10.1245/s10434-014-3607-8

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  • DOI: https://doi.org/10.1245/s10434-014-3607-8

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