Prognostic Significance of Biologic Factors in Patients with a Modest Radiologic Response to Neoadjuvant Treatment for Resectable and Borderline Resectable Pancreatic Cancers: Impact of the Combination Index of Sialyl-Lewis Antigen-Related Tumor Markers

Satoru Miyahara ^1,2, Hidenori Takahashi ^3,4, Hirofumi Akita ²

⁰Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.

Annals of Surgical Oncology +

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February 17, 2024

View abstract on PubMed

Summary

A new sialyl-Lewis related index (sLe index) combining CA19-9 and DUPAN-II tumor markers can predict recurrence after neoadjuvant treatment (NAT) in patients with modest responses. This index offers better prognostic significance than individual markers alone.

Area Of Science

Oncology
Biomarkers
Cancer Treatment Response

Background

Assessing operative eligibility after neoadjuvant treatment (NAT) is crucial, especially for patients with modest radiologic responses.
Current methods for evaluating these patients remain controversial.
Biologic factors may improve prognostic accuracy for treatment selection.

Purpose Of The Study

To evaluate the prognostic significance of biologic factors in patients with modest radiologic responses to NAT.
To investigate the predictive value of CA19-9, DUPAN-II, and a combined sialyl-Lewis related index (sLe index) for treatment outcomes.

Main Methods

Patients with stable disease or slight progression (≤20% tumor size increase) by RECIST after NAT were enrolled.
A novel sLe index was calculated by combining CA19-9 and DUPAN-II serum levels.
Prognostic significance of individual markers and the sLe index for postoperative outcomes was assessed.

Main Results

A post-NAT sLe index below 45.25 was significantly associated with favorable disease-free survival.
The sLe index demonstrated superior predictive accuracy for recurrence within 24 months compared to CA19-9 or DUPAN-II alone.
A post-NAT sLe index above 45.25 was identified as an independent predictor of recurrence within 24 months.

Conclusions

Biologic factor evaluation, particularly using the sLe index, can enhance patient selection after NAT.
The sLe index provides a simple yet powerful tool for assessing multiple sialyl-Lewis antigen-related tumor markers.
This combined marker approach offers improved prognostic significance for predicting treatment outcomes in specific patient groups.

Keywords:

Biological factor CA19-9 DUPAN-II Lewis antigen Neoadjuvant treatment Pancreatic cancer