Induction chemotherapy in pancreatic cancer: CA 19-9 may predict resectability and survival

Ulrike Heger, Huihui Sun, Ulf Hinz, Ulla Klaiber, Masayuki Tanaka, Bing Liu, Milena Sachsenmaier, Christoph Springfeld, Christoph W. Michalski, Markus W. Büchler, Thilo Hackert

Research output: Contribution to journalArticlepeer-review

42 Citations (Scopus)


Background: Preoperative/Neoadjuvant treatment (NT) is increasingly used in unresectable pancreatic cancer (PDAC). However, ∼40% of patients cannot be resected after NT and reliable preoperative response evaluation is currently lacking. We investigated CA 19-9 levels and their dynamics during NT for prediction of resectability and survival. Methods: We screened our institution's database for patients who underwent exploration or resection after NT with gemcitabine-based therapy (GEM) or FOLFIRINOX (FOL). Pre- and post-NT CA 19-9, resection rate and survival were analyzed. Results: Of 318 patients 165 (51.9%) were resected and 153 (48.1%) received exploration. In the FOL group (n = 103; 32.4%), a post-NT CA 19-9 cutoff at 91.8 U/ml had a sensitivity of 75.0% and a specificity of 76.9% for completing resection with an AUC of 0.783 in the ROC analysis (95% CI: 0.692–0.874; p < 0.001. PPV: 84.2%, NPV: 65.2%). Resected patients above the cutoff did not benefit from resection. Post-NT CA 19-9 <91.8 U/ml (OR 11.63, p < 0.001) and CA 19-9 ratio of <0.4 (OR 5.77, p = 0.001) were independent predictors for resectability in FOL patients. Discussion: CA 19-9 levels after neoadjuvant treatment with FOLFIRINOX predict resectability and survival of PDAC more accurately than dynamic values and should be incorporated into response evaluation and surgical decision-making.

Original languageEnglish
Pages (from-to)224-232
Number of pages9
Issue number2
Publication statusPublished - 2020 Feb
Externally publishedYes

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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