Patients with normal-range CA19-9 levels represent a distinct subgroup of pancreatic cancer patients

Guopei Luo, Kaizhou Jin, Meng Guo, He Cheng, Zuqiang Liu, Zhiwen Xiao, Yu Lu, Jiang Long, Liang Liu, Jin Xu, Chen Liu, Yutang Gao, Quanxing Ni, Xianjun Yu, Guopei Luo, Kaizhou Jin, Meng Guo, He Cheng, Zuqiang Liu, Zhiwen Xiao, Yu Lu, Jiang Long, Liang Liu, Jin Xu, Chen Liu, Yutang Gao, Quanxing Ni, Xianjun Yu

Abstract

Pancreatic cancer remains a lethal disease that responds poorly to multiple types of treatment. Therefore, the identification of distinct subgroups that exhibit unique therapeutic responses is an urgent requirement. In the present multicenter study (1,912 cases), the differences between the therapeutic responses and clinical characteristics of two subgroups of pancreatic cancer, carbohydrate antigen 19-9 (CA19-9)-normal (baseline serum level, ≤37 U/ml) and CA19-9-elevated (baseline serum level, >37 U/ml), were analyzed. CA19-9-normal expression was identified to be an independent prognostic factor for patients with stage I-II [hazard ratio (HR)=0.77; P=0.037] and stage III-IV (HR=0.68; P<0.001) pancreatic cancer. The 5-year survival rate of the stage III-IV CA19-9-normal subgroup was increased compared with the stage I-II CA19-9-elevated subgroup (15.4 vs. 13.8%). In the stage I-II CA19-9-normal and CA19-9-elevated subgroups, gemcitabine-based chemotherapy was a significant positive prognostic factor for survival (CA19-9-normal, HR=0.54, P=0.013; CA19-9-elevated, HR=0.55, P<0.001). However, among stage III-IV patients, the CA19-9-normal subgroup exhibited a poor response to gemcitabine-based chemotherapy (HR=0.77; P=0.165), while the CA19-9-elevated subgroup exhibited a favorable response, resulting in a lower rate of mortality (HR=0.70; P<0.001) compared with no chemotherapy. It was concluded that CA19-9-normal pancreatic cancer is a less aggressive subgroup; however, advanced CA19-9-normal pancreatic cancer exhibits a poorer response to gemcitabine-based chemotherapy.

Keywords: Lewis; carbohydrate antigen 19-9; chemotherapy; gemcitabine; pancreatic adenocarcinoma; subtype.

Figures

Figure 1.
Figure 1.
Kaplan-Meier estimators for patients with pancreatic cancer subdivided by baseline serum CA19-9 levels (CA19-9-normal, ≤37 U/ml; CA19-9-elevated, >37 U/ml), tumor stage and chemotherapy. Survival rates for patients with (A) stage I–II and (B) stage III–IV pancreatic cancer were significantly improved in the CA19-9-normal subgroups compared with the CA19-9-elevated subgroups. Among stage I–II patients, survival rates were significantly improved by treatment with gemcitabine in (C) CA19-9-normal and (D) CA19-9-elevated subgroups. Among stage III–IV patients, survival rates were not significantly improved by gemcitabine treatment in (E) the CA19-9-normal subgroup, but were in (F) the CA19-9-elevated subgroup. CA19-9, carbohydrate antigen 19-9; HR, hazard ratio; chemo., chemotherapy.

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