ArticleAnnals of surgical oncology2025
Resectable Pancreatic Cancer with CA19-9 > 500 U/mL: A Biological Indicator for Survival Benefit with Intensive Neoadjuvant Chemotherapy.
Article in Annals of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Comparative diagnostic performance of endoscopic ultrasound, MRI, and CT for preoperative assessment of pancreatic cancer: a Bayesian network meta-analysis under a graded reference standard.BMC medical imaging · 2026Pooled it
- Redefining biologically borderline resectable pancreatic cancer: a data-driven reassessment of CA19-9 cutoff and a preoperative lymph node metastasis prediction model.Surgery today · 2026Article
- Real-World Evaluation of the HELPP Score and CALLY Index for Preoperative Prognostic Stratification in Resectable Pancreatic Ductal Adenocarcinoma.Journal of clinical medicine · 2025Article
- Explainable artificial intelligence in pancreatic cancer prediction: from transparency to clinical decision-making.Frontiers in oncology · 2025Review
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Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWhile anatomical resectability guides pancreatic cancer treatment, carbohydrate antigen (19-9 (CA19-9) serves as a biological indicator of disease burden. Current guidelines suggest considering neoadjuvant chemotherapy (NAC) for cases with markedly elevated CA19-9, but specific threshold values and treatment strategies remain undefined. This retrospective study aimed to evaluate the efficacy of intensive NAC using gemcitabine plus nab-paclitaxel or fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) for anatomically resectable pancreatic cancer with elevated CA19-9 (> 500 U/mL). PATIENTS AND
methodsWe analyzed patients with anatomically resectable pancreatic cancer and CA19-9 > 500 U/mL treated between 2014 and 2022. Initial planned treatments were either 4-month intensive NAC followed by surgery (NAC group) or upfront surgery (UPS group). Survival outcomes were evaluated using retrospective intention-to-treat analysis.
resultsAmong 184 included patients, 46 received NAC and 138 underwent upfront surgery. The NAC group demonstrated significantly improved overall survival compared with the UPS group (median 52.7 vs. 22.7 months, P < 0.001). Resection rates were 89.1% and 76.1% in the NAC and UPS groups, respectively. Among resected cases, the NAC group achieved higher lymph node-negative resection rates (53.7% vs. 23.8%, P < 0.001) and better post-resection CA19-9 normalization rates (75.6% vs. 56.1%, P = 0.037). Survival benefits were maintained even in cases with CA19-9 > 2000 U/mL (median OS 52.7 vs. 18.9 months, P = 0.025).
conclusionsCA19-9 > 500 U/mL serves as an effective indicator for implementing intensive NAC in anatomically resectable pancreatic cancer. This biomarker-based strategy effectively extracts the beneficial group from NAC, prolonging survival outcomes through better systemic disease control.
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