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. 2024 Mar;31(3):1919-1932.
doi: 10.1245/s10434-023-14680-0. Epub 2024 Jan 3.

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

Deesje Doppenberg #  1   2 , Thomas F Stoop #  1   2   3 , Susan van Dieren  1 , Matthew H G Katz  4 , Quisette P Janssen  5 , Naaz Nasar  6 , Laura R Prakash  4 , Rutger T Theijse  1   2 , Ching-Wei D Tzeng  4 , Alice C Wei  6 , Amer H Zureikat  7 , Bas Groot Koerkamp #  5 , Marc G Besselink #  8   9 ; Trans-Atlantic Pancreatic Surgery (TAPS) Consortium
Affiliations

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

Deesje Doppenberg et al. Ann Surg Oncol. 2024 Mar.

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.

Keywords: Localized pancreatic adenocarcinoma; Non-elevated CA-19.9; Overall survival; Preoperative FOLFIRINOX; Serum CEA.

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