Clinicopathological Features, Recurrence Patterns, and Prognosis of Pancreatic Adenocarcinoma with Normal Serum CA19-9. A Consecutive Series of 154 Cases from a Single Institute

• Published in: Journal of gastrointestinal surgery Vol. 24; no. 4; pp. 855 - 865
• Main Authors: Zhao, Yajie, Wang, Chengfeng
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2020; Springer Nature B.V
• Subjects: Adenocarcinoma - therapy; Biomarkers, Tumor; CA-19-9 Antigen; Gastroenterology; Gastrointestinal surgery; Humans; Lymphatic system; Medical prognosis; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local; Original Article; Pancreatic cancer; Pancreatic Neoplasms - therapy; Prognosis; Retrospective Studies; Surgery; Pancreatic adenocarcinoma; Prognosis; Propensity score; Regression analysis; Multivariate analysis
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-019-04209-w

Background Serum levels of CA19-9 correlate with recurrence and survival in patients with pancreatic adenocarcinoma; however, little is known about the features and prognosis of pancreatic adenocarcinoma with normal CA19-9 levels. Method Patients with pancreatic adenocarcinoma ( n  = 806) were split into two groups with normal (≤ 37 U/mL) and elevated (> 37 U/mL) CA19–9. The clinicopathological features, survival, and recurrence patterns were compared between two groups. We also sought to identify factors that best predicted prognosis in pancreatic adenocarcinoma with normal CA19-9 levels, to assist in the selection of the most effective adjuvant treatment. Results Pancreatic adenocarcinoma with normal CA19-9 were less likely to have lymph node metastasis, angiolymphatic invasion, intrapancreatic neural invasion, anterior serosal invasion, and invasion of the surrounding tissue/organ (distal bile duct, duodenum, or splenic artery or vein). Following propensity-score matching, pancreatic adenocarcinoma with normal CA19-9 levels (≤ 37 U/ml) were associated with significantly superior overall survival following resection. Moreover, the CA19-9 ≤ 37 U/mL group demonstrated a significantly lower rate of local recurrence (35.57% vs. 52.35%, p  = 0.004), distant recurrence (42.95% vs. 60.4%, p  = 0.003), and mixed recurrence (5.37% vs. 29.53%, p  < 0.000) compared with the CA19–9 > 37 U/mL group. Multivariate analysis suggested that angiolymphatic invasion, lymph node metastases, and tumor size > 3 cm were independent prognostic factors for pancreatic adenocarcinoma with normal CA19-9. Survival analyses suggested that post-op chemoradiotherapy or chemotherapy were associated with more favorable outcomes. Conclusions Pancreatic adenocarcinoma with normal pretreatment CA19-9 levels (≤ 37 U/ml) were characterized by better biological characteristics, reduced rates of recurrence, and longer overall survival. Moreover, optimal adjuvant therapy should be performed after surgery.