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Clinical Trial
. 2008 Dec 20;26(36):5918-22.
doi: 10.1200/JCO.2008.18.6288. Epub 2008 Nov 24.

Postresection CA 19-9 predicts overall survival in patients with pancreatic cancer treated with adjuvant chemoradiation: a prospective validation by RTOG 9704

Adam C Berger  1 , Miguel Garcia Jr, John P Hoffman, William F Regine, Ross A Abrams, Howard Safran, Andre Konski, Alan B Benson 3rd, John MacDonald, Christopher G Willett
Affiliations
Clinical Trial

Postresection CA 19-9 predicts overall survival in patients with pancreatic cancer treated with adjuvant chemoradiation: a prospective validation by RTOG 9704

Adam C Berger et al. J Clin Oncol. .

Abstract

Purpose: CA 19-9 is an important tumor marker in patients with pancreatic adenocarcinoma. A secondary end point of Radiation Therapy Oncology Group trial 9704 was prospective evaluation of the ability of postresectional CA 19-9 to predict survival.

Methods: CA 19-9 expression was analyzed as a dichotomized variable (< 180 v > or = 180) or (< or = 90 v > 90). Cox proportional hazards models were utilized to identify the impact of CA 19-9 expression on overall survival (OS). Actuarial estimates for OS were calculated using Kaplan-Meier methods.

Results: Three hundred eighty-five patients patients had assessable CA 19-9 levels. The majority had a CA 19-9 level lower than 180 or < or = 90 (n = 220 and 200, respectively), while 34% were Lewis Antigen negative and 33 (9%) and 53 (14%) patients had levels higher than 180 and higher than 90. When CA 19-9 was analyzed as a dichotomized variable, there was a significant survival difference favoring patients with CA 19-9 lower than 180 (hazard ratio [HR], 3.53; P < .0001). This corresponds to a 72% reduction in the risk of death for patients with a CA 19-9 lower than 180. This was also true for patients with CA 19-9 < or = 90 (HR, 3.4; P < .0001). Multivariate analyses confirmed that CA 19-9, when analyzed as both a continuous and a dichotomized variable, is a highly significant predictor of OS in patients with resected pancreatic cancer.

Conclusion: To our knowledge, this is the first phase III trial to perform prospective analysis of CA 19-9 levels in patients treated with adjuvant chemoradiotherapy. It definitively confirms the prognostic importance of postresectional CA 19-9 levels after surgery with curative intent in patients with pancreatic cancer.

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Figures

Fig 1.
Fig 1.
Treatment schema. CRT, chemoradiotherapy; FU, fluorouracil; RT, radiation therapy.
Fig 2.
Fig 2.
Kaplan-Meier survival curve by CA 19-9 with 180 cutoff.
Fig 3.
Fig 3.
Kaplan-Meier curve for overall survival by CA 19-9 with 90 cutoff.
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