World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access
Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc
Journal website https://wjon.elmerpub.com

Original Article

Volume 16, Number 3, June 2025, pages 269-275

Prognostic Significance of Post-Neoadjuvant Chemotherapy Carbohydrate Antigen 19-9 Levels in Patients With Resectable Pancreatic Cancer Treated With S-1 and Gemcitabine: A Retrospective Cohort Study

Figure

↓  Figure 1. Kaplan-Meier curves stratified by CA19-9 levels (low vs. high). (a) Patients with low CA19-9 levels (< 100 U/mL) had significantly better disease-free survival (DFS) than those with high CA19-9 levels (median survival time (MST): low CA19-9, 24 months vs. high CA19-9, 7.0 months; P = 0.002). (b) Patients with low CA19-9 levels (< 100 U/mL) had significantly better overall survival (OS) than those with high CA19-9 levels (MST: low CA19-9, not reached vs. high CA19-9, 14.7 months; P = 0.001). CA19-9: carbohydrate antigen 19-9.
Figure 1.

Tables

↓  Table 1. Descriptive Statistics for the Total Cohort and Two Subgroups Stratified by Post-NATGS CA19-9 Levels
 
Statistics Total cohort Subgroup P value
CA19-9 < 100 CA19-9 ≥ 100
CA19-9: carbohydrate antigen 19-9; CEA: carcinoembryonic antigen; DUPAN-2: Duke pancreatic monoclonal antigen type 2; NAT: neoadjuvant therapy; GS: gemcitabine plus S-1. Location: Ph: pancreatic head; Pb: pancreatic body; Pt: pancreatic tail. RECIST: response evaluation criteria in solid tumor: CR: complete response; PR: partial response; SD: stable disease; PD: progressive disease. Operative procedures: PD: pancreaticoduodenectomy; TP: total pancreatectomy; DP: distal pancreatectomy. PV: portal vein.
Number 50 40 10
Sex, male/female 30:20 23:17 7:3 0.47
Age (years) 72 (50 - 86) 72 (56 - 86) 71 (50 - 80) 0.836
Pre-neoadjuvant CEA 2.5 (0.8 - 15.5) 2.5 (0.8 - 15.5) 2.5 (1.4 - 8.6) 0.402
Post-neoadjuvant CEA 2.55 (1 - 9.6) 2.45 (1 - 9.6) 2.7 (1.8 - 8.8) 0.308
Pre-neoadjuvant CA19-9 45.5 (5.3 - 1,379) 25 (5.8 - 232) 362 (74 - 1,379) 0.001
Post-neoadjuvant CA19-9 23.5 (2 - 1,436) 20.5 (2 - 99) 189.5 (102 - 1,436) 0.001
Pre-neoadjuvant DUPAN-2 65.5 (25 - 7,500) 42.5 (25 - 3,500) 145 (67 - 7,500) 0.006
Post-neoadjuvant DUPAN-2 37 (25 - 3,900) 26 (25 - 1,600) 140 (26 - 3,900) 0.002
Location Ph:Pb, Pt 28:22 17:23 5:5 0.731
Adverse event (hematological) ≥ grade 3 26 (52%) 21 (52.5%) 5 (50%) 0.582
Adverse event (non-hematological) ≥ grade 3 3 (6%) 2 (5%) 1 (10%) 0.4959
Completion of NAT (GS two cycles) 48 (96%) 39 (97.5%) 9 (90%) 0.363
RECIST CR:PR:SD:PD 0:5:45:0 0:4:36:0 0:1:9:0 0.347
Operative procedure (PD TP:DP) 28:22 16:24 4:6 0.302
PV resection 8 6 2 0.71
Operative time 404 (202 - 651) 400 (208 - 651) 420 (202 - 544) 0.942
Blood loss 526 (0 - 1651) 500 (0 - 1651) 794 (50 - 1396) 0.186
Tumor size 2.3 (0.3 - 6.0) 2.5 (0.3 - 3.7) 2.75 (1.5 - 4.5) 0.349
Nodal status (negative/positive) 34:26 30:10 4:6 0.056
Curative resection R0:R1:R2 43:7:0 35:5:0 8:2:0 0.541
Pathological response (Evans ≥ grade 3) 3 (6%) 3 (7.5%) 0 0.462
Complication (Clavien-Dindo 3a) 8 (16%) 6 (15%) 2 (20%) 0.768
Post-operative hospital stay 15 (9 - 46) 15 (9 - 46) 16.5 (9 - 35) 0.688
Adjuvant chemotherapy (completion) 39 30 9 0.305

 

↓  Table 2. Univariate and Multivariate Analysis of Predictive Factors for Disease-Free Survival
 
n Univariate Multivariate Hazard ratio (95% CI)
Location: Ph: pancreatic head; Pb: pancreatic body; Pt: pancreatic tail. CA19-9: carbohydrate antigen 19-9; CEA: carcinoembryonic antigen; DUPAN-2: Duke pancreatic monoclonal antigen type 2; NAT: neoadjuvant therapy; CI: confidence interval.
Age < 72, ≥ 72 24:26 0.056
Sex, man/woman 30:20 0.471
Location Ph, Pb or Pt 22:28 0.14
Post-NAT, tumor size < 1.7, ≥ 1.7 30:20 0.039
Post-NAT, nodal status negative/positive 46:4 0.828
Pre-NAT, CEA < 5.0, ≥ 5.0 45:5 0.884
Pre-NAT, CA19-9 < 100, ≥ 100 38:12 0.007
Pre-NAT, DUPAN-2 < 150, ≥ 150 38:12 0.269
Post-NAT, CEA < 5.0, ≥ 5.0 42:8 0.727
Post-NAT, CA19-9 < 100, ≥ 100 40:10 < 0.001 < 0.001 11.72251 (2.798 - 49.099)
Post-NAT, DUPAN-2 < 150, ≥ 150 33:17 0.116

 

↓  Table 3. Univariate and Multivariate Analysis of Predictive Factors for Overall Survival
 
n Univariate Multivariate Hazard ratio (95% CI)
Location: Ph: pancreatic head; Pb: pancreatic body; Pt: pancreatic tail. CA19-9: carbohydrate antigen 19-9; CEA: carcinoembryonic antigen; DUPAN-2: Duke pancreatic monoclonal antigen type 2; NAT: neoadjuvant therapy; CI: confidence interval.
Age < 72, ≥ 72 24:26 0.9258
Sex, man/woman 30:20 0.8242
Location Ph, Pb or Pt 22:28 0.849
Post-NAT, tumor size < 1.7, ≥ 1.7 30:20 0.2065
Post-NAT, nodal status negative/positive 46:4 0.5855
Pre-NAT, CEA < 5.0, ≥ 5.0 45:5 0.8884
Pre-NAT, CA19-9 < 100, ≥ 100 38:12 0.1329
Pre-NAT, DUPAN-2 < 150, ≥ 150 38:12 0.2541
Post-NAT, CEA < 5.0, ≥ 5.0 42:8 0.293
Post-NAT, CA19-9 < 100, ≥ 100 40:10 < 0.001 0.0025 17.88 (13.862 - 20,856.9)
Post-NAT, DUPAN-2 < 150, ≥ 150 33:17 0.0129 0.030 2.667 (1.5297 - 341.9195)