• Joon Kyung Kim, Danielle K DePeralta, Takuya Ogami, Jason W Denbo, Jose Pimiento, Pamela J Hodul, Mokenge P Malafa, Dae W Kim, Jason B Fleming, and Benjamin D Powers.
• Morsani College of Medicine, University of South Florida, Tampa, Florida.
• J Surg Oncol. 2020 Nov 1; 122 (6): 1074-1083.

Background And ObjectivesCurrent guidelines recommend neoadjuvant therapy for pancreatic ductal adenocarcinoma (PDAC) patients with anatomically resectable tumors but elevated CA 19-9. However, this recommendation is based on data from anatomically resectable and borderline resectable PDAC patients. Therefore, we analyzed the association of preoperative CA 19-9 with oncologic outcomes in a cohort of anatomically resectable PDAC patients.MethodsA single-institution PDAC database from 2007 to 2015 included patients who underwent guideline-based staging and were anatomically resectable. Patients with bilirubin above 1.5 after decompression, nonsecretors of CA 19-9, and borderline resectable patients were excluded. Statistical analysis included frequency testing and regression modeling for recurrence and survival.ResultsOne hundred forty-four PDAC patients were identified; 16 (11.1%) had elevated preoperative CA 19-9 ≥ 1000. A CA 19-9 level ≥1000 was not associated with demographic, clinical, or pathological factors. After adjustment for potential confounders, CA 19-9 levels (continuous, median, 500 U/mL, or 1000 U/mL cut-offs) were not associated with recurrence or overall survival (OS).ConclusionsAlthough guidelines recommend CA 19-9 to determine the management of anatomically resectable PDAC patients, CA 19-9 was not associated with recurrence or OS in this cohort. Our findings do not suggest that CA 19-9 alone should determine the PDAC treatment strategy.© 2020 Wiley Periodicals LLC.

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