Normalization of CA19-9 Following Resection for Pancreatic Ductal Adenocarcinoma is not Tantamount to being Cured?

Background: Postoperative carbohydrate antigen 19-9 (CA19-9) is an independent predictor of survival forpancreatic ductal adenocarcinoma (PDAC), and more powerful than preoperative CA19-9. However, makingdecisions just dependent on postoperative CA19-9 may result in necessary treatments not being performed.Materials and
Methods: A total of 178 patients with resected PDAC were eligible for this retrospective study,classified into two corresponding subgroups according to postoperative CA19-9. Prognostic significance of allclinicopathologic factors was evaluated by univariate and multivariate analyses.
Results: Postoperative CA19-9,preoperative CA125 and lymph node status were independent predictors. Better predictive performances foroverall survival (OS) and recurrence-free survival (RFS) were achieved by postoperative CA19-9 comparedto preoperative CA125 and lymph node status. Particularly, preoperative CA125 was associated with poor OS(p<0.001 for the normalized CA19-9 patients, p=0.012 for the elevated) and RFS (p=0.005 for the normalized,p=0.004 for the elevated). Moreover, preoperative CA125 levels related with survival in double- negative patients.
Conclusions: Normalization of CA19-9 is not tantamount to be cured. Preoperative CA125 is a critical predictorfor PDAC patients, especially in double-negative patients.