Amr I Al Abbas1,2, Mazen Zenati1, Caroline J Reiser1, Ahmad Hamad1,3, Jae Pil Jung1,4, Amer H Zureikat1, Herbert J Zeh1,2, Melissa E Hogg5,6. 1. University of Pittsburgh, Pittsburgh, PA, USA. 2. University of Texas Southwestern, Dallas, TX, USA. 3. Ohio State University, Columbus, OH, USA. 4. Andong Medical Group Hospital, Andong-si, Gyeongbuk, Korea. 5. University of Pittsburgh, Pittsburgh, PA, USA. MHogg@Northshore.org. 6. Walgreens Building, Department of Surgery 2539, Northsore University HealthSystem, 2650 Ridge Road, Evanston, IL, 60201, USA. MHogg@Northshore.org.
Abstract
BACKGROUND: The optimal cutoffs for carbohydrate antigen 19-9 (CA19-9) response after neoadjuvant therapy (NT) for pancreatic adenocarcinoma (PDAC) are not well characterized. This study aimed to analyze the relationship of serum CA19-9 to other markers of response and to identify thresholds correlating to outcomes. METHODS: A retrospective review of resected PDAC patients from 2010 to 2017 at an academic tertiary referral center was conducted. RESULTS: The analysis enrolled 250 subjects. Normalization and multiple cutoff points for CA19-9 response were assessed. Normalization was not associated with improved survival (35.17 vs. 29.43 months; p = 0.173). Although a response 45% or higher was associated with longer survival (35 vs. 20 months; p = 0.018), a response of 85% or higher was optimal (55.7 vs. 25.97 months; p < 0.0001). A response of 85% or higher remained a strong independent predictor of survival [hazard ratio (HR), 0.47; p = 0.007]. Subjects with a response of 85% or higher had received more NT cycles [3 (range 2-6) vs. 3 (range 2-4) cycles; p = 0.006] and fewer adjuvant cycles [4 (range 3-6) vs. 5 (range 3-6) cycles; p = 0.027]. Reduction in T-size correlated with a drop in CA19-9 and a size reduction of 25% or higher (56.97 vs. 28.17 months; p = 0.016) improved survival. A serum CA19-9 response of 85% or higher was a strong independent predictor of a reduction in T-size of 25% or higher (HR 2.40; p = 0.007). CONCLUSION: A CA19-9 response of 85% or higher is the optimal threshold for predicting survival. It is predictive of T-size reduction. Future NT trials should incorporate CA19-9 response as an end point.
BACKGROUND: The optimal cutoffs for carbohydrate antigen 19-9 (CA19-9) response after neoadjuvant therapy (NT) for pancreatic adenocarcinoma (PDAC) are not well characterized. This study aimed to analyze the relationship of serum CA19-9 to other markers of response and to identify thresholds correlating to outcomes. METHODS: A retrospective review of resected PDACpatients from 2010 to 2017 at an academic tertiary referral center was conducted. RESULTS: The analysis enrolled 250 subjects. Normalization and multiple cutoff points for CA19-9 response were assessed. Normalization was not associated with improved survival (35.17 vs. 29.43 months; p = 0.173). Although a response 45% or higher was associated with longer survival (35 vs. 20 months; p = 0.018), a response of 85% or higher was optimal (55.7 vs. 25.97 months; p < 0.0001). A response of 85% or higher remained a strong independent predictor of survival [hazard ratio (HR), 0.47; p = 0.007]. Subjects with a response of 85% or higher had received more NT cycles [3 (range 2-6) vs. 3 (range 2-4) cycles; p = 0.006] and fewer adjuvant cycles [4 (range 3-6) vs. 5 (range 3-6) cycles; p = 0.027]. Reduction in T-size correlated with a drop in CA19-9 and a size reduction of 25% or higher (56.97 vs. 28.17 months; p = 0.016) improved survival. A serum CA19-9 response of 85% or higher was a strong independent predictor of a reduction in T-size of 25% or higher (HR 2.40; p = 0.007). CONCLUSION: A CA19-9 response of 85% or higher is the optimal threshold for predicting survival. It is predictive of T-size reduction. Future NT trials should incorporate CA19-9 response as an end point.
Authors: Asmita Chopra; Mazen Zenati; Melissa E Hogg; Herbert J Zeh; David L Bartlett; Nathan Bahary; Amer H Zureikat; Joal D Beane Journal: Ann Surg Oncol Date: 2021-05-23 Impact factor: 5.344
Authors: Samer AlMasri; Mazen Zenati; Abdulrahman Hammad; Ibrahim Nassour; Hao Liu; Melissa E Hogg; Herbert J Zeh; Brian Boone; Nathan Bahary; Aatur D Singhi; Kenneth K Lee; Alessandro Paniccia; Amer H Zureikat Journal: JAMA Netw Open Date: 2022-06-01
Authors: Asmita Chopra; Ruben Zamora; Yoram Vodovotz; Jacob C Hodges; Derek Barclay; Randall Brand; Richard L Simmons; Kenneth K Lee; Alessandro Paniccia; Pranav Murthy; Michael T Lotze; Brian A Boone; Amer H Zureikat Journal: J Immunother Date: 2021-06-01 Impact factor: 4.912