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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2024

17-02-2024 | Pancreatic Cancer | Pancreatic Tumors

Prognostic Significance of Biologic Factors in Patients with a Modest Radiologic Response to Neoadjuvant Treatment for Resectable and Borderline Resectable Pancreatic Cancers: Impact of the Combination Index of Sialyl-Lewis Antigen-Related Tumor Markers

Authors: Satoru Miyahara, MD, Hidenori Takahashi, MD, PhD, Hirofumi Akita, MD, PhD, Kazuki Sasaki, MD, PhD, Yosuke Mukai, MD, PhD, Yoshifumi Iwagami, MD, PhD, Shinichiro Hasegawa, MD, PhD, Daisaku Yamada, MD, PhD, Yoshito Tomimaru, MD, PhD, Takehiro Noda, MD, PhD, Hiroshi Wada, MD, PhD, Shogo Kobayashi, MD, PhD, Yuichiro Doki, MD, PhD, Hidetoshi Eguchi, MD, PhD

Published in: Annals of Surgical Oncology | Issue 5/2024

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Abstract

Background

Appropriate re-evaluation after neoadjuvant treatment (NAT) is important for optimal treatment selection. Nonetheless, determining the operative eligibility of patients with a modest radiologic response remains controversial. This study aimed to assess the prognostic significance of biologic factors for patients showing a modest radiologic response to NAT and investigate the tumor markers (TMs), CA19-9 alone, DUPAN-II alone, and their combination, to create an index that combines these sialyl-Lewis antigen-related TMs associated with treatment outcomes.

Methods

This study enrolled patients deemed to have a "stable disease" by RECIST classification with slight progression (tumor size increase rate, ≤20%) as their radiologic response after NAT. A sialyl-Lewis-related index (sLe index), calculated by adding one fourth of the serum DUPAN-II value to the CA19-9 value, was created. The prognostic significances of CA19-9, DUPAN-II, and the sLe index were assessed in relation to postoperative outcomes.

Results

An sLe index lower than the cutoff value (45.25) was significantly associated with favorable disease-free survival. Moreover, the post-NAT sLe index had a higher area under the curve value for recurrence within 24 months than the post-NAT levels of CA19-9 or DUPAN-II alone. Multivariable analysis showed that a post-NAT sLe index higher than 45.25 was the single independent predictive factor for recurrence within 24 months.

Conclusions

Additional evaluation of biologic factors can potentially enhance patient selection, particularly for patients showing a limited radiologic response to NAT. The authors' index is a simple indicator for the biologic evaluation of multiple combined sialyl-Lewis antigen-related TMs and may offer a better predictive significance.
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Metadata
Title
Prognostic Significance of Biologic Factors in Patients with a Modest Radiologic Response to Neoadjuvant Treatment for Resectable and Borderline Resectable Pancreatic Cancers: Impact of the Combination Index of Sialyl-Lewis Antigen-Related Tumor Markers
Authors
Satoru Miyahara, MD
Hidenori Takahashi, MD, PhD
Hirofumi Akita, MD, PhD
Kazuki Sasaki, MD, PhD
Yosuke Mukai, MD, PhD
Yoshifumi Iwagami, MD, PhD
Shinichiro Hasegawa, MD, PhD
Daisaku Yamada, MD, PhD
Yoshito Tomimaru, MD, PhD
Takehiro Noda, MD, PhD
Hiroshi Wada, MD, PhD
Shogo Kobayashi, MD, PhD
Yuichiro Doki, MD, PhD
Hidetoshi Eguchi, MD, PhD
Publication date
17-02-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-024-14945-2

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