Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled Analysis

Gian Carlo Mattiucci, Alessio G. Morganti, Francesco Cellini, Milly Buwenge, Riccardo Casadei, Andrea Farioli, Sergio Alfieri, Alessandra Arcelli, Federica Bertini, Felipe A. Calvo, Silvia Cammelli, Lorenzo Fuccio, Lucia Giaccherini, Alessandra Guido, Joseph M Herman, Gabriella Macchia, Bert W. Maidment, Robert C. Miller, Francesco Minni, William F. Regine & 4 others Michele Reni, Stefano Partelli, Massimo Falconi, Vincenzo Valentini

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Presurgical carbohydrate antigen 19-9 (CA19-9) level predicts overall survival (OS) in resected pancreatic adenocarcinoma (PaC). The aim of this pooled analysis was to evaluate if presurgical CA19-9 level can also predict local control (LC) and distant metastasis-free survival (DMFS). METHODS: Seven hundred patients with PaC from eight institutions who underwent surgical resection ± adjuvant treatment between 2000 and 2014 were analyzed. Patients were divided based on four presurgical CA19-9 level cutoffs (5, 37, 100, 353 U/ml). Weibull regression model to identify independent predictors of OS on 404 patients with complete information was fitted. RESULTS: Median follow-up was 17 months (range: 2-225 months). Univariate analysis showed a better prognosis in pT1-2, pN0, diameter <30 mm, or grade 1 tumors and in patients undergoing R0 resection, distal pancreatectomy, or adjuvant chemotherapy and with lower CA19-9 levels. Five-year OS, LC, and DMFS were as follows: CA19-9 <5.0: 5.7%, 47.2%, 17.0%; CA19-9 5.1-37.0: 37.9%, 63.3%, 46.0%; CA19-9 37.1-100.0: 27.1%, 59.4%, 39.0%; CA19-9 100.1-353.0: 17.4%, 43.4%, 26.7%; CA19-9 >353.1: 10.9%, 50.2%, and 23.4%, respectively. At multivariate analysis, CA19-9 >100 and <353 level (P=.002), CA19-9 ≥353.1 (P<.001) level, G3 tumor (P=.002), and tumor diameter >30 mm (P<.001) correlated with worse OS. Patients treated with postoperative chemoradiation doses >50.0 Gy showed improved OS (P<.001). CONCLUSION: Presurgical CA19-9 predicts both OS and pattern of failure. Therefore, CA19-9 should be included in predictive models in order to customize treatments based on prognostic factors. Moreover, future studies should stratify patients according to presurgical CA19-9 level.

LanguageEnglish (US)
Pages1-7
Number of pages7
JournalTranslational Oncology
Volume12
Issue number1
DOIs
StatePublished - Jan 1 2019

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Adenocarcinoma
Carbohydrates
Antigens
Survival
Multivariate Analysis
Neoplasm Metastasis
Therapeutics

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Mattiucci, G. C., Morganti, A. G., Cellini, F., Buwenge, M., Casadei, R., Farioli, A., ... Valentini, V. (2019). Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled Analysis. Translational Oncology, 12(1), 1-7. https://doi.org/10.1016/j.tranon.2018.08.017

Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma : A Pooled Analysis. / Mattiucci, Gian Carlo; Morganti, Alessio G.; Cellini, Francesco; Buwenge, Milly; Casadei, Riccardo; Farioli, Andrea; Alfieri, Sergio; Arcelli, Alessandra; Bertini, Federica; Calvo, Felipe A.; Cammelli, Silvia; Fuccio, Lorenzo; Giaccherini, Lucia; Guido, Alessandra; Herman, Joseph M; Macchia, Gabriella; Maidment, Bert W.; Miller, Robert C.; Minni, Francesco; Regine, William F.; Reni, Michele; Partelli, Stefano; Falconi, Massimo; Valentini, Vincenzo.

In: Translational Oncology, Vol. 12, No. 1, 01.01.2019, p. 1-7.

Research output: Contribution to journalArticle

Mattiucci, GC, Morganti, AG, Cellini, F, Buwenge, M, Casadei, R, Farioli, A, Alfieri, S, Arcelli, A, Bertini, F, Calvo, FA, Cammelli, S, Fuccio, L, Giaccherini, L, Guido, A, Herman, JM, Macchia, G, Maidment, BW, Miller, RC, Minni, F, Regine, WF, Reni, M, Partelli, S, Falconi, M & Valentini, V 2019, 'Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled Analysis' Translational Oncology, vol. 12, no. 1, pp. 1-7. https://doi.org/10.1016/j.tranon.2018.08.017
Mattiucci, Gian Carlo ; Morganti, Alessio G. ; Cellini, Francesco ; Buwenge, Milly ; Casadei, Riccardo ; Farioli, Andrea ; Alfieri, Sergio ; Arcelli, Alessandra ; Bertini, Federica ; Calvo, Felipe A. ; Cammelli, Silvia ; Fuccio, Lorenzo ; Giaccherini, Lucia ; Guido, Alessandra ; Herman, Joseph M ; Macchia, Gabriella ; Maidment, Bert W. ; Miller, Robert C. ; Minni, Francesco ; Regine, William F. ; Reni, Michele ; Partelli, Stefano ; Falconi, Massimo ; Valentini, Vincenzo. / Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma : A Pooled Analysis. In: Translational Oncology. 2019 ; Vol. 12, No. 1. pp. 1-7.
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title = "Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma: A Pooled Analysis",
abstract = "BACKGROUND: Presurgical carbohydrate antigen 19-9 (CA19-9) level predicts overall survival (OS) in resected pancreatic adenocarcinoma (PaC). The aim of this pooled analysis was to evaluate if presurgical CA19-9 level can also predict local control (LC) and distant metastasis-free survival (DMFS). METHODS: Seven hundred patients with PaC from eight institutions who underwent surgical resection ± adjuvant treatment between 2000 and 2014 were analyzed. Patients were divided based on four presurgical CA19-9 level cutoffs (5, 37, 100, 353 U/ml). Weibull regression model to identify independent predictors of OS on 404 patients with complete information was fitted. RESULTS: Median follow-up was 17 months (range: 2-225 months). Univariate analysis showed a better prognosis in pT1-2, pN0, diameter <30 mm, or grade 1 tumors and in patients undergoing R0 resection, distal pancreatectomy, or adjuvant chemotherapy and with lower CA19-9 levels. Five-year OS, LC, and DMFS were as follows: CA19-9 <5.0: 5.7{\%}, 47.2{\%}, 17.0{\%}; CA19-9 5.1-37.0: 37.9{\%}, 63.3{\%}, 46.0{\%}; CA19-9 37.1-100.0: 27.1{\%}, 59.4{\%}, 39.0{\%}; CA19-9 100.1-353.0: 17.4{\%}, 43.4{\%}, 26.7{\%}; CA19-9 >353.1: 10.9{\%}, 50.2{\%}, and 23.4{\%}, respectively. At multivariate analysis, CA19-9 >100 and <353 level (P=.002), CA19-9 ≥353.1 (P<.001) level, G3 tumor (P=.002), and tumor diameter >30 mm (P<.001) correlated with worse OS. Patients treated with postoperative chemoradiation doses >50.0 Gy showed improved OS (P<.001). CONCLUSION: Presurgical CA19-9 predicts both OS and pattern of failure. Therefore, CA19-9 should be included in predictive models in order to customize treatments based on prognostic factors. Moreover, future studies should stratify patients according to presurgical CA19-9 level.",
author = "Mattiucci, {Gian Carlo} and Morganti, {Alessio G.} and Francesco Cellini and Milly Buwenge and Riccardo Casadei and Andrea Farioli and Sergio Alfieri and Alessandra Arcelli and Federica Bertini and Calvo, {Felipe A.} and Silvia Cammelli and Lorenzo Fuccio and Lucia Giaccherini and Alessandra Guido and Herman, {Joseph M} and Gabriella Macchia and Maidment, {Bert W.} and Miller, {Robert C.} and Francesco Minni and Regine, {William F.} and Michele Reni and Stefano Partelli and Massimo Falconi and Vincenzo Valentini",
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TY - JOUR

T1 - Prognostic Impact of Presurgical CA19-9 Level in Pancreatic Adenocarcinoma

T2 - Translational Oncology

AU - Mattiucci, Gian Carlo

AU - Morganti, Alessio G.

AU - Cellini, Francesco

AU - Buwenge, Milly

AU - Casadei, Riccardo

AU - Farioli, Andrea

AU - Alfieri, Sergio

AU - Arcelli, Alessandra

AU - Bertini, Federica

AU - Calvo, Felipe A.

AU - Cammelli, Silvia

AU - Fuccio, Lorenzo

AU - Giaccherini, Lucia

AU - Guido, Alessandra

AU - Herman, Joseph M

AU - Macchia, Gabriella

AU - Maidment, Bert W.

AU - Miller, Robert C.

AU - Minni, Francesco

AU - Regine, William F.

AU - Reni, Michele

AU - Partelli, Stefano

AU - Falconi, Massimo

AU - Valentini, Vincenzo

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND: Presurgical carbohydrate antigen 19-9 (CA19-9) level predicts overall survival (OS) in resected pancreatic adenocarcinoma (PaC). The aim of this pooled analysis was to evaluate if presurgical CA19-9 level can also predict local control (LC) and distant metastasis-free survival (DMFS). METHODS: Seven hundred patients with PaC from eight institutions who underwent surgical resection ± adjuvant treatment between 2000 and 2014 were analyzed. Patients were divided based on four presurgical CA19-9 level cutoffs (5, 37, 100, 353 U/ml). Weibull regression model to identify independent predictors of OS on 404 patients with complete information was fitted. RESULTS: Median follow-up was 17 months (range: 2-225 months). Univariate analysis showed a better prognosis in pT1-2, pN0, diameter <30 mm, or grade 1 tumors and in patients undergoing R0 resection, distal pancreatectomy, or adjuvant chemotherapy and with lower CA19-9 levels. Five-year OS, LC, and DMFS were as follows: CA19-9 <5.0: 5.7%, 47.2%, 17.0%; CA19-9 5.1-37.0: 37.9%, 63.3%, 46.0%; CA19-9 37.1-100.0: 27.1%, 59.4%, 39.0%; CA19-9 100.1-353.0: 17.4%, 43.4%, 26.7%; CA19-9 >353.1: 10.9%, 50.2%, and 23.4%, respectively. At multivariate analysis, CA19-9 >100 and <353 level (P=.002), CA19-9 ≥353.1 (P<.001) level, G3 tumor (P=.002), and tumor diameter >30 mm (P<.001) correlated with worse OS. Patients treated with postoperative chemoradiation doses >50.0 Gy showed improved OS (P<.001). CONCLUSION: Presurgical CA19-9 predicts both OS and pattern of failure. Therefore, CA19-9 should be included in predictive models in order to customize treatments based on prognostic factors. Moreover, future studies should stratify patients according to presurgical CA19-9 level.

AB - BACKGROUND: Presurgical carbohydrate antigen 19-9 (CA19-9) level predicts overall survival (OS) in resected pancreatic adenocarcinoma (PaC). The aim of this pooled analysis was to evaluate if presurgical CA19-9 level can also predict local control (LC) and distant metastasis-free survival (DMFS). METHODS: Seven hundred patients with PaC from eight institutions who underwent surgical resection ± adjuvant treatment between 2000 and 2014 were analyzed. Patients were divided based on four presurgical CA19-9 level cutoffs (5, 37, 100, 353 U/ml). Weibull regression model to identify independent predictors of OS on 404 patients with complete information was fitted. RESULTS: Median follow-up was 17 months (range: 2-225 months). Univariate analysis showed a better prognosis in pT1-2, pN0, diameter <30 mm, or grade 1 tumors and in patients undergoing R0 resection, distal pancreatectomy, or adjuvant chemotherapy and with lower CA19-9 levels. Five-year OS, LC, and DMFS were as follows: CA19-9 <5.0: 5.7%, 47.2%, 17.0%; CA19-9 5.1-37.0: 37.9%, 63.3%, 46.0%; CA19-9 37.1-100.0: 27.1%, 59.4%, 39.0%; CA19-9 100.1-353.0: 17.4%, 43.4%, 26.7%; CA19-9 >353.1: 10.9%, 50.2%, and 23.4%, respectively. At multivariate analysis, CA19-9 >100 and <353 level (P=.002), CA19-9 ≥353.1 (P<.001) level, G3 tumor (P=.002), and tumor diameter >30 mm (P<.001) correlated with worse OS. Patients treated with postoperative chemoradiation doses >50.0 Gy showed improved OS (P<.001). CONCLUSION: Presurgical CA19-9 predicts both OS and pattern of failure. Therefore, CA19-9 should be included in predictive models in order to customize treatments based on prognostic factors. Moreover, future studies should stratify patients according to presurgical CA19-9 level.

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