Serum CEA as a prognostic marker for overall survival in patients with localized pancreatic adenocarcinoma and non-elevated CA19-9 levels treated with FOLFIRINOX as initial treatment: A TAPS consortium study Journal Article
| Authors: | Doppenberg, D.; Stoop, T. F.; van Dieren, S.; Katz, M. H. G.; Janssen, Q. P.; Nasar, N.; Prakash, L. R.; Theijse, R. T.; Tzeng, C. W. D.; Wei, A. C.; Zureikat, A. H.; Groot Koerkamp, B.; Besselink, M. G.; and for the Trans-Atlantic Pancreatic Surgery (TAPS) Consortium |
| Article Title: | Serum CEA as a prognostic marker for overall survival in patients with localized pancreatic adenocarcinoma and non-elevated CA19-9 levels treated with FOLFIRINOX as initial treatment: A TAPS consortium study |
| Abstract: | Introduction: About 25% of patients with localized pancreatic adenocarcinoma have non-elevated serum carbohydrate antigen (CA) 19-9 levels at baseline, hampering evaluation of response to preoperative treatment. Serum carcinoembryonic antigen (CEA) is a potential alternative. Methods: This retrospective cohort study from five referral centers included consecutive patients with localized pancreatic adenocarcinoma (2012–2019), treated with one or more cycles of (m)FOLFIRINOX, and non-elevated CA19-9 levels (i.e., < 37 U/mL) at baseline. Cox regression analyses were performed to assess prognostic factors for overall survival (OS), including CEA level at baseline, restaging, and dynamics. Results: Overall, 277 patients were included in this study. CEA at baseline was elevated (≥5 ng/mL) in 53 patients (33%) and normalized following preoperative therapy in 14 patients (26%). In patients with elevated CEA at baseline, median OS in patients with CEA normalization following preoperative therapy was 33 months versus 19 months in patients without CEA normalization (p = 0.088). At time of baseline, only elevated CEA was independently associated with (worse) OS (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.04–1.98). At time of restaging, elevated CEA at baseline was still the only independent predictor for (worse) OS (HR 1.44, 95% CI 1.04–1.98), whereas elevated CEA at restaging (HR 1.16, 95% CI 0.77–1.77) was not. Conclusions: Serum CEA was elevated in one-third of patients with localized pancreatic adenocarcinoma having non-elevated CA19-9 at baseline. At both time of baseline and time of restaging, elevated serum CEA measured at baseline was the only predictor for (worse) OS. Therefore, serum CEA may be a useful tool for decision making at both initial staging and time of restaging in patients with non-elevated CA19-9. © Society of Surgical Oncology 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. |
| Keywords: | controlled study; retrospective studies; major clinical study; overall survival; fluorouracil; pancreatic neoplasms; follow up; antineoplastic agent; adenocarcinoma; biological marker; antineoplastic combined chemotherapy protocols; ca 19-9 antigen; carcinoembryonic antigen; cohort analysis; retrospective study; tumor marker; irinotecan; folinic acid; pancreas tumor; pancreas adenocarcinoma; preoperative treatment; oxaliplatin; leucovorin; carbohydrate antigen; ca-19-9 antigen; humans; prognosis; human; male; female; article; folfirinox; biomarkers, tumor; localized pancreatic adenocarcinoma; non-elevated ca-19.9; preoperative folfirinox; serum cea |
| Journal Title: | Annals of Surgical Oncology |
| Volume: | 31 |
| Issue: | 3 |
| ISSN: | 1068-9265 |
| Publisher: | Springer |
| Date Published: | 2024-03-01 |
| Start Page: | 1919 |
| End Page: | 1932 |
| Language: | English |
| DOI: | 10.1245/s10434-023-14680-0 |
| PUBMED: | 38170408 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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