Published online Mar 15, 2024. doi: 10.4251/wjgo.v16.i3.798
Peer-review started: September 19, 2023
First decision: December 5, 2023
Revised: December 15, 2023
Accepted: January 27, 2024
Article in press: January 27, 2024
Published online: March 15, 2024
Processing time: 175 Days and 1.4 Hours
Pancreatic ductal adenocarcinoma (PDAC) is a relatively common cancer with increasing morbidity and mortality due to changes of social environment. Studies have demonstrated that neoadjuvant therapy (NAT) is associated with increased resectability, negative surgical margins, and increased survival among patients with more locally advanced disease. Carbohydrate antigen 19-9 (CA19-9) is a dialkylated Lewis blood group antigen and is the most widely investigated tumor marker in patients with PDAC. However, CA19-9 as a biomarker has known limitations: Routine usage of CA19-9 as a screening tool for PDAC in the general public is ineffective and results in a low positive predictive value due to the relatively low incidence of PDAC in the general population. It has been shown that changes in tumor size and serum CA19-9 during NAT can capture differences that are not identified by individual measurements at a single point in time.
Our study demonstrated that post-NAT serum CA19-9 level/pre-NAT serum CA19-9 level and post-NAT tumor size/pre-NAT tumor size were independent factors associated with overall survival (OS) in patients with PDAC who received NAT and subsequent surgical resection.
This study aimed to evaluate the significance of serum CA19-9 and tumor size changes pre-and post-NAT. The ratio of post-NAT serum CA19-9 level/pre-NAT serum CA19-9 level and the ratio of post-NAT tumor size/pre-NAT tumor size were used to identify the prognostic value of these factors in patients with PDAC. Moreover, we evaluated the combined prognostic value of these factors in predicting OS in patients with PDAC.
The t-test was employed to evaluate the differences in microbiome species abundance between the groups. Two-sided P values were used, and the significance level was set at 0.05 for all analyses unless otherwise stated. SPSS software (version 26) and R software (version 4.1.2) were used for statistical analyses.
A total of 156 patients who completed NAT and subsequently underwent tumor resection were included in this study. The average age was 65.4 ± 10.6 years and 72 (46.2%) patients were female. Before survival analysis, we defined the post-NAT serum CA19-9 level/ pre-NAT serum CA19-9 level as the CA19-9 ratio (CR). The patients were divided into three groups: CR < 0.5, CR > 0.5 and < 1 and CR > 1. With regard to tumor size measured by both computed tomography and magnetic resonance imaging, we defined the post-NAT tumor size/pre-NAT tumor size as the tumor size ratio (TR). The patients were then divided into three groups: TR < 0.5, TR > 0.5 and < 1 and TR > 1. Based on these groups divided according to CR and TR, we performed both OS and disease-free survival (DFS) analyses. Log-rank tests showed that both OS and DFS were significantly different among the groups according to CR and TR (P < 0.05). CR and TR after NAT were associated with increased odds of achieving a complete or near-complete pathologic response. Moreover, CR (HR: 1.721, 95%CI: 1.373-3.762; P = 0.006), and TR (HR: 1.435, 95%CI: 1.275-4.363; P = 0.014) were identified as independent factors associated with OS.
Our study demonstrated that post-NAT serum CA19-9 level/pre-NAT serum CA19-9 level and post-NAT tumor size/pre-NAT tumor size were independent factors associated with OS in patients with PDAC who received NAT and subsequent surgical resection.
Serum CA19-9 level and post-NAT tumor size/pre-NAT tumor size were independent factors associated with OS in patients with PDAC who received NAT and subsequent surgical resection.