• Deesje Doppenberg, Jacob L van Dam, Youngmin Han, Bert A Bonsing, Olivier R Busch, Sebastiaan Festen, Erwin van der Harst, Ignace H de Hingh, Marjolein Y V Homs, Wooil Kwon, Mirang Lee, Daan J Lips, Vincent E de Meijer, I Quintus Molenaar, Joost J Nuyttens, Gijs A Patijn, Stijn van Roessel, George P van der Schelling, Mustafa Suker, Eva Versteijne, Judith de Vos-Geelen, Johanna W Wilmink, van EijckCasper H JCHJDepartment of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands., Geertjan van Tienhoven, Jin-Young Jang, Marc G Besselink, Bas Groot Koerkamp, and Dutch Pancreatic Cancer Group.
• Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.
• Br J Surg. 2023 Sep 6; 110 (10): 137413801374-1380.

BackgroundGuidelines suggest that the serum carbohydrate antigen (CA19-9) level should be used when deciding on neoadjuvant treatment in patients with resectable and borderline resectable pancreatic ductal adenocarcinoma (hereafter referred to as pancreatic cancer). In patients with resectable pancreatic cancer, neoadjuvant therapy is advised when the CA19-9 level is 'markedly elevated'. This study investigated the impact of baseline CA19-9 concentration on the treatment effect of neoadjuvant chemoradiotherapy (CRT) in patients with resectable and borderline resectable pancreatic cancers.MethodsIn this post hoc analysis, data were obtained from two RCTs that compared neoadjuvant CRT with upfront surgery in patients with resectable and borderline resectable pancreatic cancers. The effect of neoadjuvant treatment on overall survival was compared between patients with a serum CA19-9 level above or below 500 units/ml using the interaction test.ResultsOf 296 patients, 179 were eligible for analysis, 90 in the neoadjuvant CRT group and 89 in the upfront surgery group. Neoadjuvant CRT was associated with superior overall survival (HR 0.67, 95 per cent c.i. 0.48 to 0.94; P = 0.019). Among 127 patients (70, 9 per cent) with a low CA19-9 level, median overall survival was 23.5 months with neoadjuvant CRT and 16.3 months with upfront surgery (HR 0.63, 0.42 to 0.93). For 52 patients (29 per cent) with a high CA19-9 level, median overall survival was 15.5 months with neoadjuvant CRT and 12.9 months with upfront surgery (HR 0.82, 0.45 to 1.49). The interaction test for CA19-9 level exceeding 500 units/ml on the treatment effect of neoadjuvant CRT was not significant (P = 0.501).ConclusionBaseline serum CA19-9 level defined as either high or low has prognostic value, but was not associated with the treatment effect of neoadjuvant CRT in patients with resectable and borderline resectable pancreatic cancers, in contrast with current guideline advice.© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

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