Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2021; 13(11): 1423-1435
Published online Nov 27, 2021. doi: 10.4240/wjgs.v13.i11.1423
Preoperative serum carbohydrate antigen 19-9 levels predict early recurrence after the resection of early-stage pancreatic ductal adenocarcinoma
Sarang Hong, Ki Byung Song, Dae Wook Hwang, Jae Hoon Lee, Woohyung Lee, Eunsung Jun, Jaewoo Kwon, Yejong Park, Seo Young Park, Naru Kim, Dakyum Shin, Hyeyeon Kim, Minkyu Sung, Yunbeom Ryu, Song Cheol Kim
Sarang Hong, Ki Byung Song, Dae Wook Hwang, Jae Hoon Lee, Woohyung Lee, Eunsung Jun, Yejong Park, Dakyum Shin, Hyeyeon Kim, Minkyu Sung, Yunbeom Ryu, Song Cheol Kim, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, Seoul 05505, South Korea
Jaewoo Kwon, Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, South Korea
Seo Young Park, Department of Statistics and Data Science, Korea National Open University, Seoul 03087, South Korea
Naru Kim, Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, Gyeonggido 11765, South Korea
Author contributions: Hong S and Song KB designed the research; Hong S wrote the paper; Hwang DW, Lee JH, Lee W, Kwon J, and Park Y provided clinical advice; Jun E and Park SY performed analyses and interpretation of the data; Kim N, Shin D, Kim H, Sung M, Ryu Y performed the data curation; Song KB and Kim SC supervised the report.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Asan Medical Center, No. 2020-1540.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: No potential conflict of interest relevant to this article was reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ki Byung Song, MD, PhD, Associate Professor, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. mtsong21c@amc.seoul.kr
Received: May 3, 2021
Peer-review started: May 3, 2021
First decision: May 27, 2021
Revised: May 31, 2021
Accepted: August 23, 2021
Article in press: August 23, 2021
Published online: November 27, 2021
Abstract
BACKGROUND

Pancreatic ductal adenocarcinoma (PDAC) is a serious disease with a poor prognosis. Only a minority of patients undergo surgery due to the advanced stage of the disease, and patients with early-stage disease, who are expected to have a better prognosis, often experience recurrence. Thus, it is important to identify the risk factors for early recurrence and to develop an adequate treatment plan.

AIM

To evaluate the predictive factors associated with the early recurrence of early-stage PDAC.

METHODS

This study enrolled 407 patients with stage I PDAC undergoing upfront surgical resection between January 2000 and April 2016. Early recurrence was defined as a diagnosis of recurrence within 6 mo of surgery. The optimal cutoff values were determined by receiver operating characteristic (ROC) analyses. Univariate and multivariate analyses were performed to identify the risk factors for early recurrence.

RESULTS

Of the 407 patients, 98 patients (24.1%) experienced early disease recurrence: 26 (26.5%) local and 72 (73.5%) distant sites. In total, 253 (62.2%) patients received adjuvant chemotherapy. On ROC curve analysis, the optimal cutoff values for early recurrence were 70 U/mL and 2.85 cm for carbohydrate antigen 19-9 (CA 19-9) levels and tumor size, respectively. Of the 181 patients with CA 19-9 level > 70 U/mL, 59 (32.6%) had early recurrence, compared to 39 (17.4%) of 226 patients with CA 19-9 level ≤ 70 U/mL (P < 0.001). Multivariate analysis revealed that CA 19-9 level > 70 U/mL (P = 0.006), tumor size > 2.85 cm (P = 0.004), poor differentiation (P = 0.008), and non-adjuvant chemotherapy (P = 0.025) were significant risk factors for early recurrence in early-stage PDAC.

CONCLUSION

Elevated CA 19-9 level (cutoff value > 70 U/mL) can be a reliable predictive factor for early recurrence in early-stage PDAC. As adjuvant chemotherapy can prevent early recurrence, it should be recommended for patients susceptible to early recurrence.

Keywords: Pancreatic ductal adenocarcinoma, Early recurrence, Upfront surgery, Carbohydrate antigen 19-9, Adjuvant chemotherapy

Core Tip: Pancreatic ductal adenocarcinoma (PDAC) is a serious disease with a poor prognosis. Only a minority of patients undergo surgery due to the advanced stage of the disease, and recurrence, an important prognostic factor, often occurs even after surgical resection. We identified the factors associated with the early recurrence of early-stage PDAC evaluating 407 patients with stage I PDAC undergoing upfront surgical resection. Early recurrence was defined as disease recurrence within 6 mo of surgery. Preoperative carbohydrate antigen 19-9 level > 70 U/mL determined by receiver operating characteristic analyses was a significant risk factor for early recurrence in early-stage PDAC.