br Our current study suggested that CA can preceded the
Our current study suggested that CA19-9 can preceded the radiological appearance by about 3 months and tumor marker-guided early salvage therapy can delay disease progression and prolong overall survival of patients receiving resection. In patients who started their salvage treatment early, the median DFS and OS were prolonged compared with those patients who were treated only after recurrence was ascertained by radiological examinations. Approximately 80% of the recurrences of pancreatic cancer occur within two years after potentially curative treatment. When pa-tients are informed about recurrence, they have a quite limited survival. This active adjuvant chemotherapy can slow down the disease progression and benefit patients with advanced pancreatic cancer, which deserves to improve the frequency of tumor marker assay in follow-up strategy because one CA19-9 assay costs only about 15 dollars in China.
Before this study, there was a heavily debated issue among doctors in the field of oncology; that is, whether salvage treatment based only on tumor marker should be carried out or not if the clinical characteristics of the patient are good and a CT scan is negative . In addition to pancreatic cancer, tumor marker-guided treatment for other cancers has been reported. In breast cancer patients, CEAeTPAeCA15.3 tumor marker-guided salvage treatment can significantly prolong the DFS and OS in relapsing responsive patients [34,35]. Similarly, a longer OS of gastric cancer patients based on symptoms or tumor markers rather than CT was also reported . However, some study showed that CEA com-bined with CT was not significantly different from regular CT in follow up of colorectal cancer . A meta-analysis indicated that there was no survival benefit for patients with intensive follow-up after colorectal cancer resection, although more patients were treated with salvage treatment in intensive follow-up group . In addition, when to initiate salvage therapy for prostate cancer pa-tients with a prostate-specific antigen recurrence is controversial. Early hormonal treatment can only benefit patients with aggressive prostate cancer and a fast rising prostate-specific antigen, whereas in others it SB 203580 may be more harmful .
Surely, it is a highly individualized decision made by both doctor
and patient, but the clinical decision should be evidence-based. This retrospective study offers a better understanding of CA19-9 elevation and salvage treatment, which may be helpful for clini-cians to adopt the most appropriate follow-up approach. Nowa-days, liquid biopsy technology is rapidly emerging as a valuable tool in tracking therapeutic responses and our treatment strategy can be applied with G protein new technology in the future .
This study has several limitations. Our research was a retro-spective and single-institutional study with a relatively small sample size. It is obvious that tumor marker-guided treatments are based on regular follow-up, and selection bias exists objectively. Future prospective, multi-center and randomized clinical trial val-idations are needed before generalizing the results to clinical practice. Our adjuvant chemotherapy was mainly based on gem-citabine or S-1 rather than modified FOLFIRINOX (oxaliplatin plus irinotecan with leucovorin and short-term infusional fluorouracil), which have been shown to be more effective than gemcitabine alone for advanced exocrine pancreatic cancer . For future wide clinical application of this study, patients with modified FOLFIR-INOX adjuvant chemotherapy should be included. Despite these limitations, the novelty and potential applicability of this paper is still exciting. During adjuvant therapy after potentially curative surgery, CA19-9 should be assayed every 1e3 months to predict possible recurrence from our study. We hope that our findings will stimulate randomized prospective trials on the early salvage treatment effect with pancreatic cancer and facilitate decision making on switching to an active strategy.
Our study demonstrated CA19-9 elevation could precede radiographic evidence of recurrence by about 3 months in 75% patients and tumor marker-guided salvage treatment can signifi-cantly prolong DFS and OS in patients under surveillance after pancreatic cancer resection. This research may help oncologists adopt the most appropriate follow-up approach and benefit pancreatic cancer patients.
JRL, ZL, YJC and CMB conceived and designed the study. JRL, ZL and HXK collected the clinical data. JRL and YJC performed the statistical analyses. JRL wrote the manuscript. SZ, YJC and CMB reviewed and revised the manuscript. All authors read and approved the final manuscript.