• Timothy E Newhook, Timothy J Vreeland, James F Griffin, Rebecca S S Tidwell, Laura R Prakash, Eugene J Koay, Ethan B Ludmir, Brandon G Smaglo, Shubham Pant, Michael Overman, Robert A Wolff, Naruhiko Ikoma, Jessica Maxwell, Michael P Kim, Jeffrey E Lee, KatzMatthew H GMHGDepartment of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX., and TzengChing-Wei DCDDepartment of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX..
• Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
• Ann. Surg. 2023 Mar 1; 277 (3): 484490484-490.

ObjectiveTo characterize associations between carbohydrate antigen 19-9 (CA19-9) dynamics during neoadjuvant therapy (NT) and survival for patients with pancreatic ductal adenocarcinoma (PDAC).BackgroundAlthough normalization of CA19-9 during NT is associated with improved outcomes following PDAC resection, we hypothesize that CA19-9 dynamics during NT can improve prognostication.MethodsCharacteristics for patients with PDAC undergoing NT (July 2011-October 2018) with ≥3 CA19-9 results (bilirubin<2mg/dL) were collected and grouped by CA19-9 dynamics. Nonproducers (<1 U/ml) were excluded, and normal was ≤35 U/ml. Postresection survival was compared among groups.ResultsOf 431 patients, 166 had eligible CA19-9 values. Median baseline CA19-9 was 98 U/ml. Overall 2-year postresection recurrence-free survival (RFS) and overall survival (OS) were 37% and 63%, respectively. Patients with normalization (53%) had improved 2-year RFS (47% vs. 28%, P = 0.01) and OS (75% vs. 49%, P = 0.01). CA19-9 dynamics during NT were analyzed by shape, direction, and normalization creating response types ("A-B-C-D-E"). Type A was "Always" decreasing to normalization, B "Bidirectional" with eventual normalization, C "Consistently" normal, D any "Decrease" without normalization, and E "Elevating" without normalization. Types A and B responses were associated with the longest postresection 2-year RFS (51% and 56%) and OS (75% and 92%, respectively) whereas Types D and E had the worst outcomes. After adjusting for node-positivity, perineural invasion, and margin-positivity, CA19-9 response types were independently associated with both RFS and OS, and predicted outcomes are better than CA19-9 normalization alone (likelihood ratio test RFS P < 0.001, OS P = 0.01).ConclusionsThis novel A-B-C-D-E classification of CA19-9 dynamics during NT was associated with postresection outcomes more precisely than CA19-9 normalization alone.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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