caa a22 4500 445336102 CHVBK 20180317142755.0 cr unu---uuuuu 170323e20110401xx s 000 0 eng 10.1245/s10434-010-1397-1 doi (NATIONALLICENCE)springer-10.1245/s10434-010-1397-1 Failure of Normalization of CA19-9 Following Resection for Pancreatic Cancer is Tantamount to Metastatic Disease [Elektronische Daten] [Sherif Abdel-Misih, Ioannis Hatzaras, Carl Schmidt, Tanios-Bekaii Saab, Dori Klemanski, Peter Muscarella, W. Melvin, E. Ellison, Mark Bloomston] Background: Multidisciplinary therapy for pancreatic cancer involves radical resection followed by gemcitabine-based chemotherapy. Carbohydrate antigen 19-9 (CA19-9), when elevated preoperatively, is a useful marker to monitor disease status following resection. However, little has been reported on outcomes of patients in whom CA19-9 never normalizes. We hypothesize that failure of CA19-9 normalization within 6months is prognostically equivalent to metastatic disease. Methods: From our pancreatectomy database, we identified 93 patients with pancreatic adenocarcinoma and elevated CA19-9 prior to resection with levels recorded postoperatively. Patients were grouped based on normalization or persistent elevation of CA19-9 at 6months after resection. CA19-9 levels normalized (≤35u/ml) after resection in 38 (41%) and remained elevated in 55 (59%). Clinicopathologic characteristics were compared using Student's t-test and contingency table analyses. Survival curves were constructed using Kaplan-Meier method and compared by log-rank analysis. Cox regression was used to determine predictors of survival. Results: The two groups had comparable clinicopathologic characteristics except for nodal status and perineural invasion, which were higher in patients with persistently elevated CA19-9. Persistent CA19-9 conferred shorter median overall survival of 10.8months compared with 23.8months in patients with normalization (p<0.001), which persisted when controlling for nodal status. Multivariate analysis demonstrated persistently elevated CA19-9 as the sole statistically significant negative predictor of survival [hazard ratio (HR) 2.20, p=0.002]. Conclusions: Persistent CA19-9 elevation after pancreatectomy correlates with shorter survival analogous to unresected or metastatic disease and should be regarded as persistent disease regardless of radiographic findings. These patients should be considered for accrual to clinical trials or initiation of alternative therapy. Society of Surgical Oncology, 2010 Abdel-Misih Sherif Division of Surgical Oncology, The Ohio State University Medical Center/James Cancer Hospital, Columbus, OH, USA aut Hatzaras Ioannis Division of Surgical Oncology, The Ohio State University Medical Center/James Cancer Hospital, Columbus, OH, USA aut Schmidt Carl Division of Surgical Oncology, The Ohio State University Medical Center/James Cancer Hospital, Columbus, OH, USA aut Saab Tanios-Bekaii Division of Oncology, The Ohio State University Medical Center/James Cancer Hospital, Columbus, OH, USA aut Klemanski Dori Division of Surgical Oncology, The Ohio State University Medical Center/James Cancer Hospital, Columbus, OH, USA aut Muscarella Peter Division of General and Gastrointestinal Surgery, The Ohio State University Medical Center, Columbus, OH, USA aut Melvin W. Division of General and Gastrointestinal Surgery, The Ohio State University Medical Center, Columbus, OH, USA aut Ellison E. Division of General and Gastrointestinal Surgery, The Ohio State University Medical Center, Columbus, OH, USA aut Bloomston Mark Division of Surgical Oncology, The Ohio State University Medical Center/James Cancer Hospital, Columbus, OH, USA aut Annals of Surgical Oncology Springer-Verlag 18/4(2011-04-01), 1116-1121 1068-9265 18:4<1116 2011 18 10434 https://doi.org/10.1245/s10434-010-1397-1 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-010-1397-1 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Abdel-Misih Sherif Division of Surgical Oncology, The Ohio State University Medical Center/James Cancer Hospital, Columbus, OH, USA aut NATIONALLICENCE 700 1- Hatzaras Ioannis Division of Surgical Oncology, The Ohio State University Medical Center/James Cancer Hospital, Columbus, OH, USA aut NATIONALLICENCE 700 1- Schmidt Carl Division of Surgical Oncology, The Ohio State University Medical Center/James Cancer Hospital, Columbus, OH, USA aut NATIONALLICENCE 700 1- Saab Tanios-Bekaii Division of Oncology, The Ohio State University Medical Center/James Cancer Hospital, Columbus, OH, USA aut NATIONALLICENCE 700 1- Klemanski Dori Division of Surgical Oncology, The Ohio State University Medical Center/James Cancer Hospital, Columbus, OH, USA aut NATIONALLICENCE 700 1- Muscarella Peter Division of General and Gastrointestinal Surgery, The Ohio State University Medical Center, Columbus, OH, USA aut NATIONALLICENCE 700 1- Melvin W. Division of General and Gastrointestinal Surgery, The Ohio State University Medical Center, Columbus, OH, USA aut NATIONALLICENCE 700 1- Ellison E. Division of General and Gastrointestinal Surgery, The Ohio State University Medical Center, Columbus, OH, USA aut NATIONALLICENCE 700 1- Bloomston Mark Division of Surgical Oncology, The Ohio State University Medical Center/James Cancer Hospital, Columbus, OH, USA aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/4(2011-04-01), 1116-1121 1068-9265 18:4<1116 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer