CA19-9 and Nutritional Status Stratify Survival After Recurrent Pancreatic Cancer Resection

A retrospective study of 44 patients who underwent curative-intent surgery for recurrent pancreatic ductal adenocarcinoma found that preoperative CA19-9 and prognostic nutritional index were associated with overall survival. The findings may help inform surgical selection, but require validation and do not establish that resection improves outcomes.

Study included 44 patients undergoing resection for recurrent PDAC.
High CA19-9 and low PNI predicted poorer overall survival.
Combined risk groups had median survival of 61.7, 12.4, and 8.1 months.
Retrospective findings do not establish benefit from surgery.

Researchers retrospectively analyzed 44 patients who underwent curative-intent resection for recurrent pancreatic ductal adenocarcinoma after an earlier pancreatectomy between 2005 and 2023. They assessed overall survival and predictors of recurrence within six months, including preoperative CA19-9 and prognostic nutritional index (PNI), a measure of nutritional and immune status.

Median survival after resection was 32.9 months. In multivariable analysis, CA19-9 above 100 U/mL was associated with poorer overall survival (hazard ratio [HR], 3.20; p=0.004), as was PNI below 45 (HR, 3.89; p<0.001). Patients classified as low, intermediate, and high risk based on these two measures had median survival times of 61.7, 12.4, and 8.1 months, respectively (p<0.001). Low PNI also independently predicted recurrence within six months (p=0.040).

Survival varied by recurrence site, with median survival of 62.4 months for lung recurrence and 18.9 months for liver recurrence; the difference across sites was not statistically significant (p=0.075). This single-center retrospective analysis identifies prognostic associations, not evidence that surgery causes longer survival or that these thresholds should determine eligibility. The authors suggest incorporating tumor marker burden and host status into multidisciplinary assessment; external validation is needed.

In practice

For patients being considered for resection of recurrent pancreatic ductal adenocarcinoma, this retrospective study suggests that preoperative CA19-9 and PNI may help stratify prognosis: values above 100 U/mL and below 45, respectively, were associated with poorer survival. The evidence does not show that resection itself improves survival, nor does it validate these cutoffs as criteria for offering or withholding surgery. The cohort was small (44 patients) and covered 2005–2023; the findings require validation and should be considered alongside multidisciplinary assessment.

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Source

Annals of Surgical Oncology: Resection for Recurrent Pancreatic Ductal Adenocarcinoma: Preoperative CA19-9 and Host Immunonutritional Status Stratify Overall Survival ↗

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