Preoperative CA19.9 level predicts lymph node metastasis in resectable adenocarcinoma of the head of the pancreas: A further plea for biological resectability criteria

Alessandro Coppola; Vincenzo La Vaccara; Tommaso Farolfi; Horacio J Asbun; Ugo Boggi; Kevin Conlon; Bjørn Edwin; Cristina Ferrone; Eduard Jonas; Norihiro Kokudo; Elena Martin Perez; Sohei Satoi; Ernesto Sparrelid; John Stauffer; Alessandro Zerbi; Nobuyuki Takemura; Quirino Lai; Tariq Almerey; Marc Bernon; Roberto Cammarata; Yasmine Djoumi; Tom Gallagher; Poya Ghorbani; Michael Ginesini; Daisuke Hashimoto; Emanuele F Kauffmann; Dyre Kleive; Núria Lluís; Rocio Maqueda González; Niccolò Napoli; Gennaro Nappo; Martina Nebbia; Simone Ricchitelli; Mushegh A Sahakyan; Tomohisa Yamamoto; Roberto Coppola; Damiano Caputo

doi:10.1097/JS9.0000000000000773

Preoperative CA19.9 level predicts lymph node metastasis in resectable adenocarcinoma of the head of the pancreas: A further plea for biological resectability criteria

Alessandro Coppola, Vincenzo La Vaccara, Tommaso Farolfi, Horacio J Asbun, Ugo Boggi, Kevin Conlon, Bjørn Edwin, Cristina Ferrone, Eduard Jonas, Norihiro Kokudo, Elena Martin Perez, Sohei Satoi, Ernesto Sparrelid, John Stauffer, Alessandro Zerbi, Nobuyuki Takemura, Quirino Lai, Tariq Almerey, Marc Bernon, Roberto CammarataYasmine Djoumi, Tom Gallagher, Poya Ghorbani, Michael Ginesini, Daisuke Hashimoto, Emanuele F Kauffmann, Dyre Kleive, Núria Lluís, Rocio Maqueda González, Niccolò Napoli, Gennaro Nappo, Martina Nebbia, Simone Ricchitelli, Mushegh A Sahakyan, Tomohisa Yamamoto, Roberto Coppola, Damiano Caputo

Miami Cancer Institute

Research output: Contribution to journal › Article › peer-review

Abstract

INTRODUCTION: Lymph-nodal involvement (N+) represents an adverse prognostic factor after pancreatoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC). Preoperative diagnostic and staging modalities lack sensitivity for identifying N+. This study aimed to investigate preoperative CA19.9 in predicting the N+ stage in resectable-PDAC (R-PDAC).

METHODS: Patients included in a multi-institutional retrospective database of PDs performed for R-PDAC from January 2000 to June 2021 were analyzed. A preoperative laboratory value of CA19.9 >37 U/L was used in univariate and multivariate logistic regression analysis to determine a possible association with N+. Additionally, different cut-offs of CA19.9 related to the preoperative clinical T (cT) stage was assessed to evaluate the risk of N+.

RESULTS: A total of 2034 PDs from thirteen centers were included in the study. CA19.9>37 U/L was significantly associated with higher N+ at univariate and multivariate analysis (P<0.001). CA19.9 levels >37 U/L were associated with N+ in 75.9%, 81.3%, and 85.7% of patients, respectively, in cT1, cT2, and cT3 tumors and with higher cut-off values for all cT stages.

CONCLUSION: Lymph nodal involvement is strongly related to preoperative CA19.9 levels. Specially in patients staged as cT3 the CA 19.9 could represent a valid and easy tool to suspect nodal involvement. Due to these findings, R-PDAC patients with elevated CA19.9 values should be considered in a more biologically advanced stage.

Original language	English
Journal	International journal of surgery (London, England)
DOIs	https://doi.org/10.1097/JS9.0000000000000773
State	E-pub ahead of print - Aug 22 2023

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10.1097/JS9.0000000000000773

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Coppola, A., La Vaccara, V., Farolfi, T., Asbun, H. J., Boggi, U., Conlon, K., Edwin, B., Ferrone, C., Jonas, E., Kokudo, N., Perez, E. M., Satoi, S., Sparrelid, E., Stauffer, J., Zerbi, A., Takemura, N., Lai, Q., Almerey, T., Bernon, M., ... Caputo, D. (2023). Preoperative CA19.9 level predicts lymph node metastasis in resectable adenocarcinoma of the head of the pancreas: A further plea for biological resectability criteria. International journal of surgery (London, England). Advance online publication. https://doi.org/10.1097/JS9.0000000000000773

Preoperative CA19.9 level predicts lymph node metastasis in resectable adenocarcinoma of the head of the pancreas: A further plea for biological resectability criteria. / Coppola, Alessandro; La Vaccara, Vincenzo; Farolfi, Tommaso et al.
In: International journal of surgery (London, England), 22.08.2023.

Research output: Contribution to journal › Article › peer-review

Coppola, A, La Vaccara, V, Farolfi, T, Asbun, HJ, Boggi, U, Conlon, K, Edwin, B, Ferrone, C, Jonas, E, Kokudo, N, Perez, EM, Satoi, S, Sparrelid, E, Stauffer, J, Zerbi, A, Takemura, N, Lai, Q, Almerey, T, Bernon, M, Cammarata, R, Djoumi, Y, Gallagher, T, Ghorbani, P, Ginesini, M, Hashimoto, D, Kauffmann, EF, Kleive, D, Lluís, N, González, RM, Napoli, N, Nappo, G, Nebbia, M, Ricchitelli, S, Sahakyan, MA, Yamamoto, T, Coppola, R & Caputo, D 2023, 'Preoperative CA19.9 level predicts lymph node metastasis in resectable adenocarcinoma of the head of the pancreas: A further plea for biological resectability criteria', International journal of surgery (London, England). https://doi.org/10.1097/JS9.0000000000000773

@article{4168918e0fbe4874b8645ac93f711317,

title = "Preoperative CA19.9 level predicts lymph node metastasis in resectable adenocarcinoma of the head of the pancreas: A further plea for biological resectability criteria",

abstract = "INTRODUCTION: Lymph-nodal involvement (N+) represents an adverse prognostic factor after pancreatoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC). Preoperative diagnostic and staging modalities lack sensitivity for identifying N+. This study aimed to investigate preoperative CA19.9 in predicting the N+ stage in resectable-PDAC (R-PDAC).METHODS: Patients included in a multi-institutional retrospective database of PDs performed for R-PDAC from January 2000 to June 2021 were analyzed. A preoperative laboratory value of CA19.9 >37 U/L was used in univariate and multivariate logistic regression analysis to determine a possible association with N+. Additionally, different cut-offs of CA19.9 related to the preoperative clinical T (cT) stage was assessed to evaluate the risk of N+.RESULTS: A total of 2034 PDs from thirteen centers were included in the study. CA19.9>37 U/L was significantly associated with higher N+ at univariate and multivariate analysis (P<0.001). CA19.9 levels >37 U/L were associated with N+ in 75.9\%, 81.3\%, and 85.7\% of patients, respectively, in cT1, cT2, and cT3 tumors and with higher cut-off values for all cT stages.CONCLUSION: Lymph nodal involvement is strongly related to preoperative CA19.9 levels. Specially in patients staged as cT3 the CA 19.9 could represent a valid and easy tool to suspect nodal involvement. Due to these findings, R-PDAC patients with elevated CA19.9 values should be considered in a more biologically advanced stage.",

author = "Alessandro Coppola and \{La Vaccara\}, Vincenzo and Tommaso Farolfi and Asbun, \{Horacio J\} and Ugo Boggi and Kevin Conlon and Bj{\o}rn Edwin and Cristina Ferrone and Eduard Jonas and Norihiro Kokudo and Perez, \{Elena Martin\} and Sohei Satoi and Ernesto Sparrelid and John Stauffer and Alessandro Zerbi and Nobuyuki Takemura and Quirino Lai and Tariq Almerey and Marc Bernon and Roberto Cammarata and Yasmine Djoumi and Tom Gallagher and Poya Ghorbani and Michael Ginesini and Daisuke Hashimoto and Kauffmann, \{Emanuele F\} and Dyre Kleive and N{\'u}ria Llu{\'i}s and Gonz{\'a}lez, \{Rocio Maqueda\} and Niccol{\`o} Napoli and Gennaro Nappo and Martina Nebbia and Simone Ricchitelli and Sahakyan, \{Mushegh A\} and Tomohisa Yamamoto and Roberto Coppola and Damiano Caputo",

note = "Copyright {\textcopyright} 2023 The Author(s). Published by Wolters Kluwer Health, Inc.",

year = "2023",

month = aug,

day = "22",

doi = "10.1097/JS9.0000000000000773",

language = "English",

journal = "International journal of surgery (London, England)",

issn = "1743-9159",

}

TY - JOUR

T1 - Preoperative CA19.9 level predicts lymph node metastasis in resectable adenocarcinoma of the head of the pancreas

T2 - A further plea for biological resectability criteria

AU - Coppola, Alessandro

AU - La Vaccara, Vincenzo

AU - Farolfi, Tommaso

AU - Asbun, Horacio J

AU - Boggi, Ugo

AU - Conlon, Kevin

AU - Edwin, Bjørn

AU - Ferrone, Cristina

AU - Jonas, Eduard

AU - Kokudo, Norihiro

AU - Perez, Elena Martin

AU - Satoi, Sohei

AU - Sparrelid, Ernesto

AU - Stauffer, John

AU - Zerbi, Alessandro

AU - Takemura, Nobuyuki

AU - Lai, Quirino

AU - Almerey, Tariq

AU - Bernon, Marc

AU - Cammarata, Roberto

AU - Djoumi, Yasmine

AU - Gallagher, Tom

AU - Ghorbani, Poya

AU - Ginesini, Michael

AU - Hashimoto, Daisuke

AU - Kauffmann, Emanuele F

AU - Kleive, Dyre

AU - Lluís, Núria

AU - González, Rocio Maqueda

AU - Napoli, Niccolò

AU - Nappo, Gennaro

AU - Nebbia, Martina

AU - Ricchitelli, Simone

AU - Sahakyan, Mushegh A

AU - Yamamoto, Tomohisa

AU - Coppola, Roberto

AU - Caputo, Damiano

PY - 2023/8/22

Y1 - 2023/8/22

N2 - INTRODUCTION: Lymph-nodal involvement (N+) represents an adverse prognostic factor after pancreatoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC). Preoperative diagnostic and staging modalities lack sensitivity for identifying N+. This study aimed to investigate preoperative CA19.9 in predicting the N+ stage in resectable-PDAC (R-PDAC).METHODS: Patients included in a multi-institutional retrospective database of PDs performed for R-PDAC from January 2000 to June 2021 were analyzed. A preoperative laboratory value of CA19.9 >37 U/L was used in univariate and multivariate logistic regression analysis to determine a possible association with N+. Additionally, different cut-offs of CA19.9 related to the preoperative clinical T (cT) stage was assessed to evaluate the risk of N+.RESULTS: A total of 2034 PDs from thirteen centers were included in the study. CA19.9>37 U/L was significantly associated with higher N+ at univariate and multivariate analysis (P<0.001). CA19.9 levels >37 U/L were associated with N+ in 75.9%, 81.3%, and 85.7% of patients, respectively, in cT1, cT2, and cT3 tumors and with higher cut-off values for all cT stages.CONCLUSION: Lymph nodal involvement is strongly related to preoperative CA19.9 levels. Specially in patients staged as cT3 the CA 19.9 could represent a valid and easy tool to suspect nodal involvement. Due to these findings, R-PDAC patients with elevated CA19.9 values should be considered in a more biologically advanced stage.

AB - INTRODUCTION: Lymph-nodal involvement (N+) represents an adverse prognostic factor after pancreatoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC). Preoperative diagnostic and staging modalities lack sensitivity for identifying N+. This study aimed to investigate preoperative CA19.9 in predicting the N+ stage in resectable-PDAC (R-PDAC).METHODS: Patients included in a multi-institutional retrospective database of PDs performed for R-PDAC from January 2000 to June 2021 were analyzed. A preoperative laboratory value of CA19.9 >37 U/L was used in univariate and multivariate logistic regression analysis to determine a possible association with N+. Additionally, different cut-offs of CA19.9 related to the preoperative clinical T (cT) stage was assessed to evaluate the risk of N+.RESULTS: A total of 2034 PDs from thirteen centers were included in the study. CA19.9>37 U/L was significantly associated with higher N+ at univariate and multivariate analysis (P<0.001). CA19.9 levels >37 U/L were associated with N+ in 75.9%, 81.3%, and 85.7% of patients, respectively, in cT1, cT2, and cT3 tumors and with higher cut-off values for all cT stages.CONCLUSION: Lymph nodal involvement is strongly related to preoperative CA19.9 levels. Specially in patients staged as cT3 the CA 19.9 could represent a valid and easy tool to suspect nodal involvement. Due to these findings, R-PDAC patients with elevated CA19.9 values should be considered in a more biologically advanced stage.

U2 - 10.1097/JS9.0000000000000773

DO - 10.1097/JS9.0000000000000773

M3 - Article

C2 - 37738016

SN - 1743-9159

JO - International journal of surgery (London, England)

JF - International journal of surgery (London, England)

ER -