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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background
One of the reasons that pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis is that the disease is diagnosed at advanced stage. Various factors associated with PDAC prognosis have been evaluated and effort have been made to improve prognosis by early detection of the disease.
Research motivation
Serum carbohydrate antigen 19-9 (CA 19-9) has been used as a means of diagnosing malignant pancreatic neoplasm and detection of disease recurrence. However, the effectiveness of CA 19-9 as a marker for early recurrence of disease has not been well studied yet.
Research objectives
This study aimed to set the optimal cutoff preoperative CA 19-9 level and evaluate the effectiveness of CA 19-9 as a detector of early recurrence of early-stage PDAC.
Research methods
A total of 407 patients with stage I PDAC undergoing upfront surgical resection between January 2000 and April 2016 were evaluated. The optimal cutoff values were determined by receiver operating characteristic and the risk factors for early recurrence were identified using a logistic regression model.
Research results
Ninety-eight patients (24.1%) experienced early disease recurrence. The optimal cutoff value of preoperative CA 19-9 for early recurrence was determined as 70 U/mL. Patients with high CA 19-9 level showed the tendency to have early recurrence more frequently. Tumor size > 2.85 cm, poor differentiation, and non-adjuvant chemotherapy were also demonstrated to be significant risk factors for early recurrence in early-stage PDAC.
Research conclusions
Elevated CA 19-9 level can be regarded as a reliable parameter predicting early disease recurrence. Adjuvant chemotherapy should be recommended for patients susceptible to early recurrence.
Research perspectives
Preoperative CA 19-9 can be a guidance for patients to undergo effective treatment modality to reduce early recurrence, thus leading to a better prognosis.
