Abstract：
BACKGROUND: Appropriate re-evaluation after neoadjuvant treatment (NAT) is important for optimal treatment selection. Nonetheless, determining the operative eligibility of patients with a modest radiologic response remains controversial. This study aimed to assess the prognostic significance of biologic factors for patients showing a modest radiologic response to NAT and investigate the tumor markers (TMs), CA19-9 alone, DUPAN-II alone, and their combination, to create an index that combines these sialyl-Lewis antigen-related TMs associated with treatment outcomes.
METHODS: This study enrolled patients deemed to have a \"stable disease\" by RECIST classification with slight progression (tumor size increase rate, ≤20%) as their radiologic response after NAT. A sialyl-Lewis-related index (sLe index), calculated by adding one fourth of the serum DUPAN-II value to the CA19-9 value, was created. The prognostic significances of CA19-9, DUPAN-II, and the sLe index were assessed in relation to postoperative outcomes.
RESULTS: An sLe index lower than the cutoff value (45.25) was significantly associated with favorable disease-free survival. Moreover, the post-NAT sLe index had a higher area under the curve value for recurrence within 24 months than the post-NAT levels of CA19-9 or DUPAN-II alone. Multivariable analysis showed that a post-NAT sLe index higher than 45.25 was the single independent predictive factor for recurrence within 24 months.
CONCLUSIONS: Additional evaluation of biologic factors can potentially enhance patient selection, particularly for patients showing a limited radiologic response to NAT. The authors\' index is a simple indicator for the biologic evaluation of multiple combined sialyl-Lewis antigen-related TMs and may offer a better predictive significance.
METHODS: This study enrolled patients deemed to have a \"stable disease\" by RECIST classification with slight progression (tumor size increase rate, ≤20%) as their radiologic response after NAT. A sialyl-Lewis-related index (sLe index), calculated by adding one fourth of the serum DUPAN-II value to the CA19-9 value, was created. The prognostic significances of CA19-9, DUPAN-II, and the sLe index were assessed in relation to postoperative outcomes.
RESULTS: An sLe index lower than the cutoff value (45.25) was significantly associated with favorable disease-free survival. Moreover, the post-NAT sLe index had a higher area under the curve value for recurrence within 24 months than the post-NAT levels of CA19-9 or DUPAN-II alone. Multivariable analysis showed that a post-NAT sLe index higher than 45.25 was the single independent predictive factor for recurrence within 24 months.
CONCLUSIONS: Additional evaluation of biologic factors can potentially enhance patient selection, particularly for patients showing a limited radiologic response to NAT. The authors\' index is a simple indicator for the biologic evaluation of multiple combined sialyl-Lewis antigen-related TMs and may offer a better predictive significance.
摘要：
背景：新辅助治疗（NAT）后适当的重新评估对于选择最佳治疗方案很重要。尽管如此，确定放射学反应适度的患者的手术资格仍存在争议.本研究旨在评估对NAT有适度放射学反应的患者的生物学因素的预后意义，并研究肿瘤标志物（TM）。仅CA19-9，只有DUPAN-II,和他们的组合，创建一个结合这些与治疗结果相关的唾液酸-Lewis抗原相关的TM的指数。
方法：这项研究纳入了根据RECIST分类被认为患有“稳定疾病”且轻度进展的患者（肿瘤大小增加率，≤20%）作为NAT后的放射学反应。唾液酸-刘易斯相关指数(sLe指数)，通过将血清DUPAN-II值的四分之一添加到CA19-9值来计算，被创造了。CA19-9、DUPAN-II、评估sLe指数与术后结局的关系.
结果：sLe指数低于临界值（45.25）与良好的无病生存率显著相关。此外，对于24个月内的复发,NAT后sLe指数的曲线下面积高于NAT后单独CA19-9或DUPAN-II水平.多变量分析显示，NAT后sLe指数高于45.25是24个月内复发的独立预测因素。
结论：对生物因素的额外评估可能会提高患者的选择，特别是对于对NAT的放射学反应有限的患者。作者指数是多种唾液酸-Lewis抗原相关TM的生物学评估的简单指标，可能提供更好的预测意义。
方法：这项研究纳入了根据RECIST分类被认为患有“稳定疾病”且轻度进展的患者（肿瘤大小增加率，≤20%）作为NAT后的放射学反应。唾液酸-刘易斯相关指数(sLe指数)，通过将血清DUPAN-II值的四分之一添加到CA19-9值来计算，被创造了。CA19-9、DUPAN-II、评估sLe指数与术后结局的关系.
结果：sLe指数低于临界值（45.25）与良好的无病生存率显著相关。此外，对于24个月内的复发,NAT后sLe指数的曲线下面积高于NAT后单独CA19-9或DUPAN-II水平.多变量分析显示，NAT后sLe指数高于45.25是24个月内复发的独立预测因素。
结论：对生物因素的额外评估可能会提高患者的选择，特别是对于对NAT的放射学反应有限的患者。作者指数是多种唾液酸-Lewis抗原相关TM的生物学评估的简单指标，可能提供更好的预测意义。
