ASO Author Reflections: Prognostic Value of the Preoperative Tumor Marker Index in Resected Pancreatic Ductal Adenocarci
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Prognostic Value of the Preoperative Tumor Marker Index in Resected Pancreatic Ductal Adenocarcinoma: A Retrospective Single Institutional Study Tatsunori Miyata, MD, PhD, Hiromitsu Hayashi, MD, PhD, and Hideo Baba, MD, PhD, FACS Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
PAST A multidiscipline strategy, including neoadjuvant therapies, can prolong patients’ prognosis with PDAC, because they can downstage PDAC, improve the rate of curative resection, and reduce recurrence after pancreatic resection.1,2 In addition, neoadjuvant therapies could provide the favorable long-term outcome not only to patients with borderline PDAC, but also to those with resectable PDAC. In the development of treatment strategies for PDAC, preoperative biomarker is required to optimally evaluate tumor aggressiveness and improve the selection of patients with high probabilities of recurrence.3 Carbohydrate antigen 19–9 (CA19-9) is one of the most common biomarkers in therapies for pancreas cancer; however, some cases are Lewis antibody-negative cases.4 In this era of new strategies for the treatment for PDAC, we need to identify patients who are predicted to have a poor prognosis, such as cases with a high risk of recurrence. PRESENT We defined preoperative tumor marker (Pre TI) as the total scores of adjusted CA19-9, carcinoembryonic antigen (CEA), detection of a pancreatic cancer-associated antigen-2 (DUpan-2) and s-pancreas-1 antigen (SPan-1) (range; 0–3, low \ 1, and high C 2), and analyzed 183 patients who were performed pancreatic resection for
PDAC, including 110 with high Pre TI (60.1%) and 73 with low Pre TI (39.9%). A high Pre TI was significantly associated with a larger tumor and lymph node metastases, and patients with a high Pre TI resulted in worse prognostic outcomes both in relapse-free survival (RFS) (log-rank P \ 0.0001) and overall survival (OS) (log-rank P \ 0.0001) compared with those of patients with a low Pre TI. The Pre TI was an independent poor prognostic factor for RFS (hazard ratio [HR]: 2.36, P \ 0.0001) and OS (HR: 2.27, P \ 0.0001). In addition, even in the patients with normal adjusted CA19-9 values (n = 74, 40.4%), there was a significantly poor prognosis in the group with the high Pre TI group compared with those in the low group (RFS: log-rank P = 0.002; OS: log-rank P = 0.031) .5 FUTURE Our result suggested the Pre TI could be a potent predictive marker of prognostic outcomes in patients with resections for PDAC. We should pay attention not only to CA19-9 but also to the status of the other three tumor markers in preoperative managements, and patients with a high Pre TI may need additional strategies to improve their prognosis. To validate our findings, further large-scale studies are necessary to address how to select patients who could benefit most from this treatment strategy. DISCLOSURE
None of the authors has any conflict of interest.
REFERENCES Ó Society of Surgical Oncology 2020
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