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Carbohydrate antigen 19‐9 change during chemotherapy for advanced pancreatic adenocarcinoma
Author(s) -
Reni Michele,
Cereda Stefano,
Balzano Gianpaolo,
Passoni Paolo,
Rog Alessia,
Fugazza Clara,
Mazza Elena,
Zerbi Alessandro,
Di Carlo Valerio,
Villa Eugenio
Publication year - 2009
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.24302
Subject(s) - medicine , pancreatic cancer , basal (medicine) , gastroenterology , univariate analysis , multivariate analysis , chemotherapy , adenocarcinoma , ca19 9 , cancer , urology , insulin
BACKGROUND: Radiologic assessment of tumor response in pancreatic cancer is complicated by desmoplastic reactions within or around the tumor. The objective of this study was to evaluate the correlation between a decline in carbohydrate antigen 19‐9 (CA 19‐9) and survival in patients with advanced pancreatic cancer who received upfront chemotherapy. METHODS: CA 19‐9 serum basal values were measured in 247 patients with advanced pancreatic cancer who were enrolled in 5 consecutive trials between 1997 and 2007. Survival curves were compared among patients who had a predefined CA 19‐9 nadir variation (<50%. Group 1; 50% to 89%, Group 2; or >89%, Group 3). To eliminate guarantee‐time bias, survival analysis was repeated using the landmark method. RESULTS: In both univariate and multivariate analysis, the basal CA 19‐9 value significantly predicted survival. The median survival was 15.5 months for 34 patients who had normal basal CA 19‐9 values, 11.9 months for 108 patients who had basal values between 38 U/mL and 1167 U/mL, and 8 months for 105 patients who had basal values >1167 U/mL. At least 1 CA 19‐9 follow‐up value was available for 204 patients who had baseline values greater than normal. A significant difference in overall survival was observed in univariate and multivariate analyses between Groups 1 and 2, between Groups 1 and 3, and between Groups 2 and 3. The results were confirmed using the landmark method. CONCLUSIONS: In this study, baseline CA 19‐9 was confirmed as an independent prognostic factor for survival, and it may be considered as a stratification factor in trials in patients with advanced pancreatic cancer. Biochemical response may be used as a complementary measure to radiologic response to provide a better assessment of chemotherapy activity and to drive treatment decisions in clinical practice. Cancer 2009. © 2009 American Cancer Society.