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Regine WF, Winter K, Abrams RA, Safran H, Kessel IL, Chen Y, Fugazzi JA, Donnelly ED, DiPetrillo TA, Narayan S, Plastaras JP, Gaur R, Delouya G, Suh JH, Meyer JE, Haddock MG, Didolkar MS, Padula GD, Johnson D, Hoffman JP, Crane CH
Postresection CA19-9 and margin status as predictors of recurrence after adjuvant treatment for pancreatic carcinoma: Analysis of NRG oncology RTOG trial 9704
Advances in Radiation Oncology (2018) 3:154-162.
Abstract
Purpose: NRG Oncology RTOG 9704 was the first adjuvant trial to validate the prognostic value of postresection CA19-9 levels for survival in patients with pancreatic carcinoma. The data resulting from this study also provide information about predictors of recurrence that may be used to tailor individualized management in this disease setting. This secondary analysis assessed the prognostic value of postresection CA19-9 and surgical margin status (SMS) in predicting patterns of disease recurrence. Methods and materials: This multicenter cooperative trial included participants who were enrolled as patients at oncology treatment sites in the United States and Canada. The study included 451 patients analyzable for SMS, of whom 385 were eligible for postresection CA19-9 analysis. Postresection CA19-9 was analyzed at cut points of 90, 180, and continuously. Patterns of disease recurrence included local/regional recurrence (LRR) and distant failure (DF). Multivariable analyses included treatment, tumor size, and nodal status. To adjust for multiple comparisons, a P value of .01 to /= 90 was associated with increased LRR and DF. Results were similar at the 180 cut point. Conclusions: In this prospective evaluation, postresection CA19-9 was a significant predictor of both LRR and DF, whereas SMS was not. These findings support consideration of adjuvant radiation therapy dose intensification in patients with elevated postresection CA19-9.
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Publication Date: 2018-04-01.
PMCID: PMC6000159
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Last updated on Friday, December 06, 2019