Preoperative Predictive Effect Of CA19-9 And CA125 Of Resectability In Patients With Pancreatic Ductal Adenocarcinoma

Background The resectability of the tumor in patients with pancreatic ductal adenocarcinoma(PDACs)is the most important part in the preoperative evaluation.Preoperative multidisciplinary discussions(MDT)are performed to assess the safety of the procedure and the resectability of the tumor.According to existing clinical practice guidelines,the criteria of resectability of pancreatic ductal adenocarcinoma are still based on imaging.In clinical practice,there existed patients whose tumors found to be unresectable(local tumor progression or micro-metastasis)during the surgery,and thus it was impossible to perform R0 resection.Methods Patients from January 2009 to December 2016 evaluated to be resectable by preoperative evaluation and diagnosed as pancreatic adenocarcinoma pathologically are involved in the database.These patients are divided into “resectable group” and “unresectable group”,according to the situation during the surgery,whether the R0 resection could be performed.The characteristics and risk factors of unresectability were subsequently analyzed by mono-factor analysis,multi-factor analysis,Logistic regression and ROC curves.Results The unresectable group shows higher CA19-9(p<0.001),corrected CA19-9(p<0.001),CA125(p<0.001),total bilirubin(p=0.045),direct bilirubin(p=0.028),carcinoembryonic antigen(p=0.016)and tumor diameter(p<=0.015)than the resectable group.Logistic regression analysis was performed to build a model based on the four indices(corrected CA19-9,CA125,direct bilirubin and tumor diameter)to contribute to a regression equation,estimating the probability of the unresectability of the tumor(ROC curve=0.802),the cut-off of probability is 0.576.According to the model,the patients were divided into predictive positive group and predictive negative group.In the survival function,the survival time of the two groups was statistically different.Conclusion Corrected CA19-9,CA125,direct bilirubin,tumor diameter can contribute to construct a semi-supervised Logistic regression model,which can be used to predict the probability of failure of R0 resection in the surgery.Combining MDT and radiology,this model may help patients who are evaluated to be resectable in radiology to better predict the risk of invasive surgeries and reduce unnecessary surgical trauma to patients.