Sustained Elevation of Postoperative Serum Level of Carbohydrate Antigen 19-9 is High-Risk Stigmata for Primary Hepatic Recurrence in Patients with Curatively Resected Pancreatic Adenocarcinoma.
Adenocarcinoma
/ secondary
Adult
Aged
Aged, 80 and over
CA-19-9 Antigen
/ blood
Female
Humans
Liver Neoplasms
/ secondary
Male
Middle Aged
Neoplasm Recurrence, Local
/ pathology
Pancreatic Neoplasms
/ pathology
Peritoneal Neoplasms
/ secondary
Postoperative Period
Preoperative Period
Prognosis
Retrospective Studies
Survival Rate
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
pubmed:
10
10
2018
medline:
25
6
2019
entrez:
10
10
2018
Statut:
ppublish
Résumé
Survival after surgery for pancreatic adenocarcinoma (PA) is poor and heterogeneous, even for curative (R0) resection. Serum carbohydrate antigen (CA) 19-9 levels are important prognostic markers for resected PA. However, sustained elevation of CA19-9 in association with the patterns of recurrence has been rarely investigated. Patients who underwent R0 resection (n = 539) were grouped according to postoperative serum CA19-9 levels (Group E: sustained elevation; Group N: no elevation). Clinicopathological factors, patterns of recurrence, and survival were compared between the groups. Group E (n = 159) had significantly shorter median overall survival (17.1 vs. 35.4 months, p < 0.0001) than Group N (n = 380). Postoperative CA19-9 elevation was a significant independent predictor of poor survival in multivariate analysis (hazard ratio 1.98, p < 0.0001). The rate of hepatic recurrence in Group E was 2.6-fold higher than in Group N (45% vs. 17%, p < 0.0001). Postoperative CA19-9 elevation was a strongest independent predictor of primary hepatic recurrence (p < 0.0001) by a multiple regression model. Loco-regional, peritoneal, and other distant recurrence did not differ between the groups. The extent of preoperative CA19-9 elevation was correlated sustained elevation of CA19-9 after surgery (p < 0.0001) and primary hepatic recurrence (p = 0.0019). Sustained CA19-9 elevation was strong predictor of primary hepatic recurrence and short survival in cases of R0 resection for PA.
Sections du résumé
BACKGROUND
BACKGROUND
Survival after surgery for pancreatic adenocarcinoma (PA) is poor and heterogeneous, even for curative (R0) resection. Serum carbohydrate antigen (CA) 19-9 levels are important prognostic markers for resected PA. However, sustained elevation of CA19-9 in association with the patterns of recurrence has been rarely investigated.
METHODS
METHODS
Patients who underwent R0 resection (n = 539) were grouped according to postoperative serum CA19-9 levels (Group E: sustained elevation; Group N: no elevation). Clinicopathological factors, patterns of recurrence, and survival were compared between the groups.
RESULTS
RESULTS
Group E (n = 159) had significantly shorter median overall survival (17.1 vs. 35.4 months, p < 0.0001) than Group N (n = 380). Postoperative CA19-9 elevation was a significant independent predictor of poor survival in multivariate analysis (hazard ratio 1.98, p < 0.0001). The rate of hepatic recurrence in Group E was 2.6-fold higher than in Group N (45% vs. 17%, p < 0.0001). Postoperative CA19-9 elevation was a strongest independent predictor of primary hepatic recurrence (p < 0.0001) by a multiple regression model. Loco-regional, peritoneal, and other distant recurrence did not differ between the groups. The extent of preoperative CA19-9 elevation was correlated sustained elevation of CA19-9 after surgery (p < 0.0001) and primary hepatic recurrence (p = 0.0019).
CONCLUSIONS
CONCLUSIONS
Sustained CA19-9 elevation was strong predictor of primary hepatic recurrence and short survival in cases of R0 resection for PA.
Identifiants
pubmed: 30298281
doi: 10.1007/s00268-018-4814-4
pii: 10.1007/s00268-018-4814-4
doi:
Substances chimiques
CA-19-9 Antigen
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
634-641Subventions
Organisme : Japan Society for the Promotion of Science
ID : 16K10588
Organisme : Japan Society for the Promotion of Science
ID : 24592018
Références
Ann Surg. 2001 Dec;234(6):758-68
pubmed: 11729382
J Clin Oncol. 2006 Jun 20;24(18):2897-902
pubmed: 16782929
Dig Surg. 2008;25(3):226-32
pubmed: 18577869
Ann Surg Oncol. 2008 Oct;15(10):2773-86
pubmed: 18612703
Am J Clin Oncol. 2008 Oct;31(5):446-53
pubmed: 18838880
J Clin Oncol. 2008 Dec 20;26(36):5918-22
pubmed: 19029412
Ann Surg. 2008 Dec;248(6):1014-22
pubmed: 19092346
Ann Surg Oncol. 2009 May;16(5):1231-40
pubmed: 19263172
J Gastrointest Surg. 2009 Nov;13(11):2050-8
pubmed: 19756875
Ann Surg. 2010 Mar;251(3):461-9
pubmed: 20134315
Ann Surg Oncol. 2010 Jul;17(7):1794-801
pubmed: 20162463
Ann Surg Oncol. 2010 Jun;17(6):1471-4
pubmed: 20180029
Ann Surg Oncol. 2010 Sep;17(9):2321-9
pubmed: 20336387
Surgery. 2011 Mar;149(3):311-20
pubmed: 20817204
JAMA. 2010 Sep 8;304(10):1073-81
pubmed: 20823433
Ann Surg Oncol. 2011 Feb;18(2):371-9
pubmed: 20842460
Ann Surg Oncol. 2011 Apr;18(4):1116-21
pubmed: 21042945
Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):e743-8
pubmed: 21129857
Am J Clin Oncol. 2011 Dec;34(6):567-72
pubmed: 21150564
J Surg Oncol. 2011 Aug 1;104(2):155-61
pubmed: 21520097
Ann Surg. 2011 Aug;254(2):311-9
pubmed: 21606835
Ann Surg Oncol. 2012 Feb;19(2):636-41
pubmed: 21863360
Ann Surg Oncol. 2013 Nov;20(12):3794-801
pubmed: 23838925
JAMA. 2013 Oct 9;310(14):1473-81
pubmed: 24104372
N Engl J Med. 2013 Oct 31;369(18):1691-703
pubmed: 24131140
Anticancer Res. 1995 Sep-Oct;15(5B):2181-6
pubmed: 8572621