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03-01-2024 | Pancreatic Tumors

Serum CEA as a Prognostic Marker for Overall Survival in Patients with Localized Pancreatic Adenocarcinoma and Non-Elevated CA19-9 Levels Treated with FOLFIRINOX as Initial Treatment: A TAPS Consortium Study

Authors: Deesje Doppenberg, MD, PhD, Thomas F. Stoop, MD, Susan van Dieren, MSc, PhD, Matthew H. G. Katz, MD, Quisette P. Janssen, MD, PhD, Naaz Nasar, MD, Laura R. Prakash, MD, Rutger T. Theijse, BSc, Ching-Wei D. Tzeng, MD, Alice C. Wei, MD, PhD, Amer H. Zureikat, MD, PhD, Bas Groot Koerkamp, MD, PhD, Marc G. Besselink, MD, MSc, PhD, for the Trans-Atlantic Pancreatic Surgery (TAPS) Consortium

Published in: Annals of Surgical Oncology | Issue 3/2024

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Abstract

Introduction

About 25% of patients with localized pancreatic adenocarcinoma have non-elevated serum carbohydrate antigen (CA) 19-9 levels at baseline, hampering evaluation of response to preoperative treatment. Serum carcinoembryonic antigen (CEA) is a potential alternative.

Methods

This retrospective cohort study from five referral centers included consecutive patients with localized pancreatic adenocarcinoma (2012–2019), treated with one or more cycles of (m)FOLFIRINOX, and non-elevated CA19-9 levels (i.e., < 37 U/mL) at baseline. Cox regression analyses were performed to assess prognostic factors for overall survival (OS), including CEA level at baseline, restaging, and dynamics.

Results

Overall, 277 patients were included in this study. CEA at baseline was elevated (≥5 ng/mL) in 53 patients (33%) and normalized following preoperative therapy in 14 patients (26%). In patients with elevated CEA at baseline, median OS in patients with CEA normalization following preoperative therapy was 33 months versus 19 months in patients without CEA normalization (p = 0.088). At time of baseline, only elevated CEA was independently associated with (worse) OS (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.04–1.98). At time of restaging, elevated CEA at baseline was still the only independent predictor for (worse) OS (HR 1.44, 95% CI 1.04–1.98), whereas elevated CEA at restaging (HR 1.16, 95% CI 0.77–1.77) was not.

Conclusions

Serum CEA was elevated in one-third of patients with localized pancreatic adenocarcinoma having non-elevated CA19-9 at baseline. At both time of baseline and time of restaging, elevated serum CEA measured at baseline was the only predictor for (worse) OS. Therefore, serum CEA may be a useful tool for decision making at both initial staging and time of restaging in patients with non-elevated CA19-9.
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Literature
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Metadata
Title
Serum CEA as a Prognostic Marker for Overall Survival in Patients with Localized Pancreatic Adenocarcinoma and Non-Elevated CA19-9 Levels Treated with FOLFIRINOX as Initial Treatment: A TAPS Consortium Study
Authors
Deesje Doppenberg, MD, PhD
Thomas F. Stoop, MD
Susan van Dieren, MSc, PhD
Matthew H. G. Katz, MD
Quisette P. Janssen, MD, PhD
Naaz Nasar, MD
Laura R. Prakash, MD
Rutger T. Theijse, BSc
Ching-Wei D. Tzeng, MD
Alice C. Wei, MD, PhD
Amer H. Zureikat, MD, PhD
Bas Groot Koerkamp, MD, PhD
Marc G. Besselink, MD, MSc, PhD
for the Trans-Atlantic Pancreatic Surgery (TAPS) Consortium
Publication date
03-01-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2024
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-14680-0
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