Favorable Response Defined by CA19-9 Reduction After Neoadjuvant Treatment for Pancreatic Cancer

Neoadjuvant treatment (NAT) for pancreatic cancer has been shown to reduce mortality risk, with carbohydrate antigen (CA)19-9 response indicating survival outcomes. The purpose of this study is to clarify the degree of the CA19-9 response after neoadjuvant treatment (NAT) on prognosis.

In this retrospective, multicenter, observational study involving 1811 patients with pancreatic cancer scheduled for surgery, patients were stratified on the basis of pretreatment CA19-9 levels into elevated CA19-9 level and CA19-9 within the normal range groups. The groups were further divided into upfront surgery (UPS) and NAT subgroups.

Patients with high CA19-9 levels had significantly poorer prognoses compared with those with normal levels. Among the high CA19-9 group, patients undergoing NAT demonstrated significantly improved prognoses compared with those receiving UPS. Further analysis of the high CA19-9 and received NAT group stratified by CA19-9 response showed clearly different median survivals: normalized CA19-9 group > decreased but not normalized CA19-9 group > increased CA19-9 after NAT group. Notably, patients with post-NAT CA19-9 levels < 296 U/mL (eightfold of upper limit) and > 40% reduction in CA19-9 levels had equivalent prognoses as those with normalized CA19-9 levels, while those with post-NAT CA19-9 levels > 296 U/mL and/or < 40% reduction in its value had a worse prognosis, akin to those with increased CA19-9 after NAT.

NAT improves the prognosis of patients with pancreatic cancer with high CA19-9 levels, allowing for clear stratification of patients into favorable responders, defined as those with post-NAT normalized CA19-9 or levels < 296 U/mL with a > 40% reduction in CA19-9, and unfavorable responders.