Association of neoadjuvant chemotherapy with outcomes in patients with elevated preoperative Ca 19-9 undergoing pancreatic ductal adenocarcinoma resection

BACKGROUND: Serum Ca 19-9 is the most widely used biomarker in pancreatic ductal adenocarcinoma (PDAC). This study assessed the link between preoperative Ca 19-9, neoadjuvant chemotherapy (ChTNeo), and outcomes after pancreatic resection. RESEARCH DESIGN AND METHODS: = 58). ChTNeo was administered to 99 patients (30.9%) in the elevated group and 35 (60.3%) in the normal group. RESULTS: Local recurrence, distant metastases, and mortality were significantly more frequent in patients with elevated Ca 19-9, while progression-free and overall survival were shorter. Patients with normal Ca 19-9 had excellent outcomes regardless of ChTNeo. Patients with elevated preoperative Ca 19-9 and ChTNeo administration had significantly better outcomes than those undergoing upfront surgery. CONCLUSIONS: Normal preoperative Ca 19-9 identifies a group with a favorable prognosis after PDAC resection. Elevated preoperative Ca 19-9 is associated with worse oncological outcomes. Among these patients, ChTNeo was associated with better treatment outcomes than upfront surgery; however, because baseline Ca 19-9 levels before ChTNeo were unavailable, these findings should not be interpreted as evidence that elevated baseline Ca 19-9 predicts benefit from neoadjuvant chemotherapy.