Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2024; 16(3): 798-809
Published online Mar 15, 2024. doi: 10.4251/wjgo.v16.i3.798
Combining prognostic value of serum carbohydrate antigen 19-9 and tumor size reduction ratio in pancreatic ductal adenocarcinoma
Dong-Qin Xia, Yong Zhou, Shuang Yang, Fang-Fei Li, Li-Ya Tian, Yan-Hua Li, Hai-Yan Xu, Cai-Zhi Xiao, Wei Wang
Dong-Qin Xia, Shuang Yang, Fang-Fei Li, Li-Ya Tian, Yan-Hua Li, Hai-Yan Xu, Cai-Zhi Xiao, Wei Wang, Oncology Treatment Center of Traditional Chinese Medicine, Chongqing University Cancer Hospital, Chongqing 400030, China
Yong Zhou, Department of Oncology, Chongqing Weisiteng Biotech Translational Research Institute, Chongqing 430039, China
Yong Zhou, Chongqing Key Laboratory on Big Data for Bio Intelligence, Chongqing University of Posts and Telecommunications, Chongqing 430065, China
Co-first authors: Dong-Qin Xia and Shuang Yang.
Co-corresponding authors: Cai-Zhi Xiao and Wei Wang.
Author contributions: All authors contributed to the study’s conception and design; Yang S, Li FF, Tian LY, Li YH, Xu HY, Xiao CZ performed data collection and analysis; Xia DQ, Zhou Y, and Wang W wrote the manuscript; Xia DQ, Zhou Y polished and revised the manuscript; Xiao CZ, Wang W performed supervision; Xiao CZ, Wang W performed project administration; All authors commented on previous versions of the manuscript and read and approved the final manuscript. Xia DQ and Yang S contributed equally to this work as co-first authors. Xiao CZ and Wang W contributed equally to this work as co-corresponding authors. The reasons for designating Xia DQ and Yang S as co-first authors, Xiao CZ and Wang W as co-corresponding authors are threefold. First, the research was performed as a collaborative effort, and the designation of co-first authors and co-corresponding authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and management of post-submission matters, ultimately enhancing the paper's quality and reliability. Second, the overall research team encompassed authors with a variety of expertise and skills from different fields, and the designation of co-first authors and co-corresponding authors best reflects this diversity. This also promotes the most comprehensive and in-depth examination of the research topic, ultimately enriching readers' understanding by offering various expert perspectives. Third, Xia DQ and Yang S, Xiao CZ and Wang W contributed efforts of equal substance throughout the research process. The choice of these researchers as co-first authors and co-corresponding authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study. In summary, we believe that designating Xia DQ and Yang S as co-first authors, Xiao CZ and Wang W as co-corresponding authors are fitting for our manuscript as it accurately reflects our team's collaborative spirit, equal contributions, and diversity.
Supported by Natural Science Foundation of Chongqing, China, No. cstc2021jcyj-msxmX0501; and Chongqing Medical Scientific Research Project (Joint Project of Chongqing Health Commission and Science and Technology Bureau), No. 2022QNXM074.
Institutional review board statement: The study was approved by the Ethics Committee of the Institutional Review Board of the Chongqing University Cancer Hospital. Written informed consent was waived owing to the retrospective and deidentified nature of the study.
Informed consent statement: The written informed consent was waived owing to the retrospective and deidentified nature of this study.
Conflict-of-interest statement: The authors who have taken part in this study have nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Wang, MD, PhD, Professor, Oncology Treatment Center of Traditional Chinese Medicine, Chongqing University Cancer Hospital, No. 181 Hanyu Road, Chongqing 400030, China. zuiailicip@126.com
Received: September 19, 2023
Peer-review started: September 19, 2023
First decision: December 5, 2023
Revised: December 15, 2023
Accepted: January 27, 2024
Article in press: January 27, 2024
Published online: March 15, 2024
ARTICLE HIGHLIGHTS
Research background

Pancreatic ductal adenocarcinoma (PDAC) is a relatively common cancer with increasing morbidity and mortality due to changes of social environment. Studies have demonstrated that neoadjuvant therapy (NAT) is associated with increased resectability, negative surgical margins, and increased survival among patients with more locally advanced disease. Carbohydrate antigen 19-9 (CA19-9) is a dialkylated Lewis blood group antigen and is the most widely investigated tumor marker in patients with PDAC. However, CA19-9 as a biomarker has known limitations: Routine usage of CA19-9 as a screening tool for PDAC in the general public is ineffective and results in a low positive predictive value due to the relatively low incidence of PDAC in the general population. It has been shown that changes in tumor size and serum CA19-9 during NAT can capture differences that are not identified by individual measurements at a single point in time.

Research motivation

Our study demonstrated that post-NAT serum CA19-9 level/pre-NAT serum CA19-9 level and post-NAT tumor size/pre-NAT tumor size were independent factors associated with overall survival (OS) in patients with PDAC who received NAT and subsequent surgical resection.

Research objectives

This study aimed to evaluate the significance of serum CA19-9 and tumor size changes pre-and post-NAT. The ratio of post-NAT serum CA19-9 level/pre-NAT serum CA19-9 level and the ratio of post-NAT tumor size/pre-NAT tumor size were used to identify the prognostic value of these factors in patients with PDAC. Moreover, we evaluated the combined prognostic value of these factors in predicting OS in patients with PDAC.

Research methods

The t-test was employed to evaluate the differences in microbiome species abundance between the groups. Two-sided P values were used, and the significance level was set at 0.05 for all analyses unless otherwise stated. SPSS software (version 26) and R software (version 4.1.2) were used for statistical analyses.

Research results

A total of 156 patients who completed NAT and subsequently underwent tumor resection were included in this study. The average age was 65.4 ± 10.6 years and 72 (46.2%) patients were female. Before survival analysis, we defined the post-NAT serum CA19-9 level/ pre-NAT serum CA19-9 level as the CA19-9 ratio (CR). The patients were divided into three groups: CR < 0.5, CR > 0.5 and < 1 and CR > 1. With regard to tumor size measured by both computed tomography and magnetic resonance imaging, we defined the post-NAT tumor size/pre-NAT tumor size as the tumor size ratio (TR). The patients were then divided into three groups: TR < 0.5, TR > 0.5 and < 1 and TR > 1. Based on these groups divided according to CR and TR, we performed both OS and disease-free survival (DFS) analyses. Log-rank tests showed that both OS and DFS were significantly different among the groups according to CR and TR (P < 0.05). CR and TR after NAT were associated with increased odds of achieving a complete or near-complete pathologic response. Moreover, CR (HR: 1.721, 95%CI: 1.373-3.762; P = 0.006), and TR (HR: 1.435, 95%CI: 1.275-4.363; P = 0.014) were identified as independent factors associated with OS.

Research conclusions

Our study demonstrated that post-NAT serum CA19-9 level/pre-NAT serum CA19-9 level and post-NAT tumor size/pre-NAT tumor size were independent factors associated with OS in patients with PDAC who received NAT and subsequent surgical resection.

Research perspectives

Serum CA19-9 level and post-NAT tumor size/pre-NAT tumor size were independent factors associated with OS in patients with PDAC who received NAT and subsequent surgical resection.