Changes in CRP and CA19-9 during Preoperative Oncological Therapy Predict Postoperative Survival in Pancreatic Ductal Adenocarcinoma

Abstract

<b><i>Introduction:</i></b> Tumor and systemic inflammatory markers predict survival. This retrospective study aimed to explore the changes in CRP, CA19-9, and other routine laboratory tests during preoperative oncological therapy as prognostic factors in pancreatic ductal adenocarcinoma (PDAC). <b><i>Methods:</i></b> Between 2000 and 2016, 68 borderline resectable PDAC patients received preoperative oncological therapy and underwent subsequent surgery at Helsinki University Hospital, Finland. We investigated changes in CRP, CA19-9, CEA, albumin, leukocytes, bilirubin, and platelets and examined the impact on survival. <b><i>Results:</i></b> In the multivariate analysis, CRP remaining at ≥3 mg/L after preoperative oncological therapy predicted a poorer postoperative outcome when compared to CRP decreasing to or remaining at &#x3c;3 mg/L (hazard ratio [HR] 2.766, 95% confidence interval [CI]: 1.300–5.885, <i>p</i> = 0.008). Furthermore, a CA19-9 decrease &#x3e;90% during preoperative treatment predicted a favorable postoperative outcome (HR 0.297, 95% CI: 0.124–0.708, <i>p</i> = 0.006). In the Kaplan-Meier analysis, the median survival for patients with CRP remaining at &#x3c;3 mg/L was longer than among patients with an increased CRP level at ≥3 mg/L (42 months vs. 24 months, <i>p</i> = 0.001). Patients with a CA19-9 decrease &#x3e;90% or level normalization (to ≤37 kU/L) during preoperative treatment exhibited a median survival of 47 months; those with a 50–90% decrease, 15 months; and those with a &#x3c;50% decrease, 17 months (<i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Changes in CRP and CA19-9 during preoperative oncological therapy predict postoperative survival.