Exploring the role of CA 19-9 dynamics in pancreatic cancer multidisciplinary treatment: Proposal of the PANC classification.

Abstract

Advancements in multiagent chemotherapy have transformed the management of pancreatic cancer as a systemic disease, with surgery playing a crucial role in determining prognosis. Serum carbohydrate antigen 19-9 remains the most critical biomarker for assessing treatment response and guiding clinical decisions. This study aimed to evaluate carbohydrate antigen 19-9 dynamics around chemotherapy and surgery to optimize treatment strategies and improve patient outcomes. We retrospectively analyzed pancreatic cancer patients who received preoperative chemotherapy followed by radical resection. Based on carbohydrate antigen 19-9 response patterns before and after chemotherapy, as well as after surgery, we established the PANC classification and assessed its prognostic significance. Among 283 patients, the median overall survival was 56.3 months, and recurrence-free survival was 26.0 months. The PANC classification categorized patients as follows: type 1 (Preoperative normalization), 148 patients (52.3%), type 2 (After-surgery normalization), 103 patients (36.4%), type 3 (Non-normalized Decline), 12 patients (4.2%), and type 4 (Complex dynamics), 20 patients (7.1%). Type 1 and 2 responses were associated with favorable overall survival (61.1 and 57.8 months) and recurrence-free survival (35.0 and 25.6 months), whereas type 3 and 4 responses were associated with poorer outcomes. A multivariate Cox proportional hazard model identified types 1 and 2 (versus types 3 and 4) as independent prognostic factors (hazard ratio = 3.20; 95% confidence interval, 1.99-5.16; P < .001) along with other important factors. The PANC classification provides a practical framework for categorizing carbohydrate antigen 19-9 dynamics. It can be easily aligned with diverse treatment strategies across various institutions and regions, ultimately improving patient outcomes.