%0 Journal Article
%T Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled Analysis
%A Alessandra Arcelli
%A Alessandra Guido
%A Alessio G. Morganti
%A Andrea Farioli
%A Bert W. Maidment
%A III
%A Federica Bertini
%A Felipe A. Calvo
%A Francesco Cellini
%A Francesco Minni
%A Gabriella Macchia
%A Gian Carlo Mattiucci
%A Joseph M. Herman
%A Lorenzo Fuccio
%A Lucia Giaccherini
%A Massimo Falconi
%A Michele Reni
%A Milly Buwenge
%A Riccardo Casadei
%A Robert C. Miller
%A Sergio Alfieri
%A Silvia Cammelli
%A Stefano Partelli
%A Vincenzo Valentini
%A William F. Regine
%J Archive of "Translational Oncology".
%D 2019
%R 10.1016/j.tranon.2018.08.017
%X BACKGROUND: Presurgical carbohydrate antigen 19-9 (CA19-9) level predicts overall survival (OS) in resected pancreatic adenocarcinoma (PaC). The aim of this pooled analysis was to evaluate if presurgical CA19-9 level can also predict local control (LC) and distant metastasis-free survival (DMFS). METHODS: Seven hundred patients with PaC from eight institutions who underwent surgical resection ¡À adjuvant treatment between 2000 and 2014 were analyzed. Patients were divided based on four presurgical CA19-9 level cutoffs (5, 37, 100, 353 U/ml). Weibull regression model to identify independent predictors of OS on 404 patients with complete information was fitted. RESULTS: Median follow-up was 17 months (range: 2-225 months). Univariate analysis showed a better prognosis in pT1-2, pN0, diameter <30 mm, or grade 1 tumors and in patients undergoing R0 resection, distal pancreatectomy, or adjuvant chemotherapy and with lower CA19-9 levels. Five-year OS, LC, and DMFS were as follows: CA19-9 <5.0: 5.7%, 47.2%, 17.0%; CA19-9 5.1-37.0: 37.9%, 63.3%, 46.0%; CA19-9 37.1-100.0: 27.1%, 59.4%, 39.0%; CA19-9 100.1-353.0: 17.4%, 43.4%, 26.7%; CA19-9 >353.1: 10.9%, 50.2%, and 23.4%, respectively. At multivariate analysis, CA19-9 >100 and <353 level (P=.002), CA19-9 ¡Ý353.1 (P<.001) level, G3 tumor (P=.002), and tumor diameter >30 mm (P<.001) correlated with worse OS. Patients treated with postoperative chemoradiation doses >50.0 Gy showed improved OS (P<.001). CONCLUSION: Presurgical CA19-9 predicts both OS and pattern of failure. Therefore, CA19-9 should be included in predictive models in order to customize treatments based on prognostic factors. Moreover, future studies should stratify patients according to presurgical CA19-9 level
%U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143718/