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08.10.2018 | Original Scientific Report (including Papers Presented at Surgical Conferences)

Sustained Elevation of Postoperative Serum Level of Carbohydrate Antigen 19-9 is High-Risk Stigmata for Primary Hepatic Recurrence in Patients with Curatively Resected Pancreatic Adenocarcinoma

Zeitschrift:
World Journal of Surgery
Autoren:
Fuyuhiko Motoi, Yoshiaki Murakami, Ken-ichi Okada, Ippei Matsumoto, Kenichiro Uemura, Sohei Satoi, Masayuki Sho, Goro Honda, Takumi Fukumoto, Hiroaki Yanagimoto, Shoichi Kinoshita, Masanao Kurata, Shuichi Aoki, Masamichi Mizuma, Hiroki Yamaue, Michiaki Unno, for the Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS)
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00268-018-4814-4) contains supplementary material, which is available to authorized users.

Abstract

Background

Survival after surgery for pancreatic adenocarcinoma (PA) is poor and heterogeneous, even for curative (R0) resection. Serum carbohydrate antigen (CA) 19-9 levels are important prognostic markers for resected PA. However, sustained elevation of CA19-9 in association with the patterns of recurrence has been rarely investigated.

Methods

Patients who underwent R0 resection (n = 539) were grouped according to postoperative serum CA19-9 levels (Group E: sustained elevation; Group N: no elevation). Clinicopathological factors, patterns of recurrence, and survival were compared between the groups.

Results

Group E (n = 159) had significantly shorter median overall survival (17.1 vs. 35.4 months, p < 0.0001) than Group N (n = 380). Postoperative CA19-9 elevation was a significant independent predictor of poor survival in multivariate analysis (hazard ratio 1.98, p < 0.0001). The rate of hepatic recurrence in Group E was 2.6-fold higher than in Group N (45% vs. 17%, p < 0.0001). Postoperative CA19-9 elevation was a strongest independent predictor of primary hepatic recurrence (p < 0.0001) by a multiple regression model. Loco-regional, peritoneal, and other distant recurrence did not differ between the groups. The extent of preoperative CA19-9 elevation was correlated sustained elevation of CA19-9 after surgery (p < 0.0001) and primary hepatic recurrence (p = 0.0019).

Conclusions

Sustained CA19-9 elevation was strong predictor of primary hepatic recurrence and short survival in cases of R0 resection for PA.

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Zusatzmaterial
Supplemental Figure: Relationship between the extent of postoperative CA19-9 and primary hepatic recurrence, recurrence-free survival. ULN indicated Upper Limit of Normal (37 U/ml) CA19-9 values (PPTX 97 kb)
268_2018_4814_MOESM1_ESM.pptx
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