The prognostic value of CA19-9 response after neoadjuvant therapy in patients with pancreatic cancer: a systematic revie
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ORIGINAL ARTICLE
The prognostic value of CA19‑9 response after neoadjuvant therapy in patients with pancreatic cancer: a systematic review and pooled analysis Chen Ye1 · Abuduhaibaier Sadula1 · Siqian Ren1 · Xin Guo1 · Meng Yuan1 · Chunhui Yuan1 · Dianrong Xiu1 Received: 21 June 2020 / Accepted: 3 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Pancreatic cancer (PC) is a highly aggressive and refractory disease, with disappointing 5-year survival rates. Regarding the wide application of neoadjuvant treatment in patients with PC, how the post-neoadjuvant Carbohydrate antigen 19-9 (CA19-9) response could translate into a survival benefit is not clearly understood. We aimed to evaluate the correlation of the CA19-9 response with overall survival (OS) in patients with PC receiving neoadjuvant therapy. Methods An extensive electronic search in PubMed, Embase, and the Cochrane Library was performed to identify relevant articles, from which data relevant to independent correlations of the CA19-9 response with overall survival (OS) were extracted for analysis. A random-effects model was used to calculate the pooled hazard ratios (HRs) with their corresponding 95% confidence intervals (CIs). Results Altogether, 17 eligible studies were identified in the systematic review. Pooled analysis showed that CA19-9 response > 50% (HR, 0.43; 95% CI 0.29–0.56; P 50% after neoadjuvant treatment is significantly associated with promising overall survival in PDAC patients (HR = 0.47, 95% CI 0.33–0.61, P 50% response
7
Kobayashi [16] 2014, Japan
Mie University
Prosp
100
R, BR, LA
NCCN 2010
NCRT
Gem based
40 > 50% response
8
Aldakkak [17] 2015, USA
MCW
Retro
235
R, BR
MCW
NCT + NCRT
NR
95 normalized
7
Williams [18] 2016, USA
UCLA
Retro
109
BR, LA
AHPBA/SSO/ SSAT
NCT
5-FU based and others
40 normalized
5
Murakami [19] 2017, Japan
Hiroshima University Hospital
Retro
66
BR
NCCN 2016
NCT
Gem based or FOLFIRINOX
29 normalized
6
Rajamanickam [20] 2017, USA
MCW
Retro
123
R, BR
NCCN 2016
NCT, NCRT NCT + NCRT
NR
63 normalized
7
Retro Reni [21] 2017, IRCCS Italy Ospedale San Raffaele
223
BR, LA
NCCN 2014
NCT
Gem based
37 > 50% response
7
Tsai [22] 2018, USA
Retro
131
R, BR
MCW
NCT, NCRT NCT + NCRT
NR
58 normalized
8
Dhir [23] 2018, UPMC USA
Retro
193
R, BR
NCCN 2017
NCT or NCRT Gem based or FOLFIRINOX
142 normalized; 90 > 80% response
7
Truty [24] 2019, USA
Mayo Clinic
Retro
194
BR/LA
NR
NCT + NCRT
FOLFIRINOX or GA
101 normalized 8
Yoo [25] 2019, Korea
AMC
Retro
135
BR,LA
NCCN 2016
NCT
Gem based or FOLFIRINOX
58 normalized
7
Macedo [26] 2019, USA
CPC
Retro
274
BR,LA
Alliance classification
NCT or NCRT FOLFIRINOX or GA
75 > 50% response
7
Aoki [27] 2020, Multicenter Japan Study
Retro
240
R, BR
NCCN 2016
NCT or NCRT NR
33 normalized
7
Maeda [28] 2020, USA
Mayo Clinic Rochester, University of California, and Tohoku University
Retro
305
R, BR
NCCN 2017
146 normalized 7 NC
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