TY - JOUR
T1 - Postresection CA19-9 and margin status as predictors of recurrence after adjuvant treatment for pancreatic carcinoma
T2 - Analysis of NRG oncology RTOG trial 9704
AU - Regine, William F.
AU - Winter, Kathryn
AU - Abrams, Ross A.
AU - Safran, Howard
AU - Kessel, Ivan L.
AU - Chen, Yuhchyau
AU - Fugazzi, James A.
AU - Donnelly, Eric D.
AU - DiPetrillo, Thomas A.
AU - Narayan, Samir
AU - Plastaras, John P.
AU - Gaur, Rakesh
AU - Delouya, Guila
AU - Suh, John H.
AU - Meyer, Joshua E.
AU - Haddock, Michael G.
AU - Didolkar, Mukund S.
AU - Padula, Gilbert D.A.
AU - Johnson, David
AU - Hoffman, John P.
AU - Crane, Christopher H.
N1 - Publisher Copyright:
© 2018
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Purpose: NRG Oncology RTOG 9704 was the first adjuvant trial to validate the prognostic value of postresection CA19-9 levels for survival in patients with pancreatic carcinoma. The data resulting from this study also provide information about predictors of recurrence that may be used to tailor individualized management in this disease setting. This secondary analysis assessed the prognostic value of postresection CA19-9 and surgical margin status (SMS) in predicting patterns of disease recurrence. Methods and materials: This multicenter cooperative trial included participants who were enrolled as patients at oncology treatment sites in the United States and Canada. The study included 451 patients analyzable for SMS, of whom 385 were eligible for postresection CA19-9 analysis. Postresection CA19-9 was analyzed at cut points of 90, 180, and continuously. Patterns of disease recurrence included local/regional recurrence (LRR) and distant failure (DF). Multivariable analyses included treatment, tumor size, and nodal status. To adjust for multiple comparisons, a P value of ≤.01 was considered statistically significant and >.01 to ≤.05 to be a trend. Results: For CA19-9, 132 (34%) patients were Lewis antigen–negative (no CA19-9 expression), 200 (52%) had levels <90, and 220 (57%) had levels <180. A total of 188 patients (42%) had negative margins, 152 (34%) positive, and 111 (25%) unknown. On univariate analysis, CA19-9 cut at 90 was associated with increases in LRR (trend) and DF. Results were similar at the 180 cut point. SMS was not associated with an increase in LRR on univariate or multivariate analyses. On multivariable analysis, CA19-9 ≥ 90 was associated with increased LRR and DF. Results were similar at the 180 cut point. Conclusions: In this prospective evaluation, postresection CA19-9 was a significant predictor of both LRR and DF, whereas SMS was not. These findings support consideration of adjuvant radiation therapy dose intensification in patients with elevated postresection CA19-9.
AB - Purpose: NRG Oncology RTOG 9704 was the first adjuvant trial to validate the prognostic value of postresection CA19-9 levels for survival in patients with pancreatic carcinoma. The data resulting from this study also provide information about predictors of recurrence that may be used to tailor individualized management in this disease setting. This secondary analysis assessed the prognostic value of postresection CA19-9 and surgical margin status (SMS) in predicting patterns of disease recurrence. Methods and materials: This multicenter cooperative trial included participants who were enrolled as patients at oncology treatment sites in the United States and Canada. The study included 451 patients analyzable for SMS, of whom 385 were eligible for postresection CA19-9 analysis. Postresection CA19-9 was analyzed at cut points of 90, 180, and continuously. Patterns of disease recurrence included local/regional recurrence (LRR) and distant failure (DF). Multivariable analyses included treatment, tumor size, and nodal status. To adjust for multiple comparisons, a P value of ≤.01 was considered statistically significant and >.01 to ≤.05 to be a trend. Results: For CA19-9, 132 (34%) patients were Lewis antigen–negative (no CA19-9 expression), 200 (52%) had levels <90, and 220 (57%) had levels <180. A total of 188 patients (42%) had negative margins, 152 (34%) positive, and 111 (25%) unknown. On univariate analysis, CA19-9 cut at 90 was associated with increases in LRR (trend) and DF. Results were similar at the 180 cut point. SMS was not associated with an increase in LRR on univariate or multivariate analyses. On multivariable analysis, CA19-9 ≥ 90 was associated with increased LRR and DF. Results were similar at the 180 cut point. Conclusions: In this prospective evaluation, postresection CA19-9 was a significant predictor of both LRR and DF, whereas SMS was not. These findings support consideration of adjuvant radiation therapy dose intensification in patients with elevated postresection CA19-9.
UR - http://www.scopus.com/inward/record.url?scp=85045202910&partnerID=8YFLogxK
U2 - 10.1016/j.adro.2018.01.003
DO - 10.1016/j.adro.2018.01.003
M3 - Article
AN - SCOPUS:85045202910
SN - 2452-1094
VL - 3
SP - 154
EP - 162
JO - Advances in Radiation Oncology
JF - Advances in Radiation Oncology
IS - 2
ER -