背景:切除后的碳水化合物抗原(CA)19-9水平被认为可以预测预后;但是,新辅助治疗后CA19-9水平下降的意义尚未明确.本研究旨在确定胰腺腺癌患者新辅助治疗后CA19-9水平降低的预后意义。
方法:在2001年至2012年期间,240名连续患者在日本7个高容量机构接受了新辅助治疗和随后的切除。这些患者分为三组:正常组(新辅助治疗前后无升高[≤37U/ml]),反应者组(新辅助治疗前水平升高[>37U/ml],但之后水平降低[≤37U/ml]),和无应答组(新辅助治疗后水平升高[>37U/ml])。分析总生存期和复发模式。进行单因素和多因素分析以阐明影响总生存率的临床病理因素。在这些组中还评估了初始转移部位。
结果:应答者组的预后优于非应答者组(3年总生存率:50.6%和41.6%,分别,P=0.026),但预后与正常组相当(3年总生存率:54.2%,P=0.934)。根据接收机工作特性曲线的分析,定义为新辅助治疗后无升高的CA19-9临界值≤103U/ml.多变量分析显示,CA19-9水平≤103U/ml,(P=0.010,危险比:1.711;95%置信区间:1.133-2.639),肿瘤大小≤27毫米(P=0.040,1.517;(1.018-2.278)),缺乏淋巴结转移(P=0.002,1.905;(1.276-2.875)),和R0状态(P=0.045,1.659;1.012-2.627)是总生存期的显著预测因子。此外,与无反应者组(31%)相比,反应者组显示出较低的肝复发风险(18%),虽然在局部区域没有显著差异,组间观察到腹膜或其他远处复发(分别为P=0.058,P=0.700和P=0.350).
结论:新辅助治疗后CA19-9水平降低预示着更好的预后,术后肝脏复发率低。
BACKGROUND: Carbohydrate antigen (CA) 19-9 levels after resection are considered to predict prognosis; however, the significance of decreased CA19-9 levels after neoadjuvant therapy has not been clarified. This study aimed to define the prognostic significance of decreased CA19-9 levels after neoadjuvant therapy in patients with pancreatic adenocarcinoma.
METHODS: Between 2001 and 2012, 240 consecutive patients received neoadjuvant therapy and subsequent resection at seven high-volume institutions in Japan. These patients were divided into three groups: Normal group (no elevation [≤37 U/ml] before and after neoadjuvant therapy), Responder group (elevated levels [> 37 U/ml] before neoadjuvant therapy but decreased levels [≤37 U/ml] afterwards), and Non-responder group (elevated levels [> 37 U/ml] after neoadjuvant therapy). Analyses of overall survival and recurrence patterns were performed. Uni- and multivariate analyses were performed to clarify the clinicopathological factors influencing overall survival. The initial metastasis sites were also evaluated in these groups.
RESULTS: The Responder group received a better prognosis than the Non-responder group (3-year overall survival: 50.6 and 41.6%, respectively, P = 0.026), but the prognosis was comparable to the Normal group (3-year overall survival: 54.2%, P = 0.934). According to the analysis of the receiver operating characteristic curve, the CA19-9 cut-off level defined as no elevation after neoadjuvant therapy was ≤103 U/ml. The multivariate analysis revealed that a CA19-9 level ≤ 103 U/ml, (P = 0.010, hazard ratio: 1.711; 95% confidence interval: 1.133-2.639), tumor size ≤27 mm (P = 0.040, 1.517; (1.018-2.278)), a lack of lymph node metastasis (P = 0.002, 1.905; (1.276-2.875)), and R0 status (P = 0.045, 1.659; 1.012-2.627) were significant predictors of overall survival. Moreover, the Responder group showed a lower risk of hepatic recurrence (18%) compared to the Non-responder group (31%), though no significant difference in loco-regional, peritoneal or other distant recurrence were observed between groups (P = 0.058, P = 0.700 and P = 0.350, respectively).
CONCLUSIONS: Decreased CA19-9 levels after neoadjuvant therapy predicts a better prognosis, with low incidence of hepatic recurrence after surgery.