Li J, et al. JOP. J Pancreas (Online) 2010 Jul 5; 11(4):310-312. [Reference 9]

Role of surveillance CT scans in resected PC: Correlation with CA19-9 and symptoms.

Vaccaro V, Fleming JB, Wolff RA, Evans DB, Tamm EP, Crane CH, et al.

J Clin Oncol 2010; 28(15 Suppl):4113. [Full text]

Background: There is no data on the value of surveillance CT scans in pts with resected pancreatic adenocarcinoma (PC). In practice, onset of symptoms and/or abnormal blood tests including rising CA 19-9 often provides a leading indicator of disease recurrence. Methods: We performed a retrospective review to assess the value of surveillance CT scans (every 4-6 mo) compared to clinical symptoms and CA 19-9 levels. We collected data on pts with PC who underwent potentially curative surgery from Feb 1998 to Dec 2008. Results: 476 pts underwent 479 surgeries (Whipple= 417, Total = 9, Distal = 53). Of these, 308 (65%) recurred (299 definite, 9 suspicious), 15 (3%) were lost to follow-up and 156 (33%) were without recurrence and alive at last follow-up (117, 25%) or died of other causes (39). Site of first recurrence was distant and/or regional in 269 (87%) and isolated local recurrence in 35 (11%). Ca19-9 and symptoms data on 296 pts is available. 161 pts were symptomatic, 147 in the 3 mo preceding their CT. In 65, symptoms were clearly related to their cancer recurrence and in 82, correlation was not definite; residual effects from surgery or adjuvant therapy may have contributed. Correlation between CA19-9, symptoms and survival in pts that recurred is shown in the Table. In 40 (15%), cancer recurrence was noted only on body CT scan in the absence of symptoms and/or elevation of CA19-9. In 37, CT scan showed distant and/or regional recurrence, and only 3 pts showed isolated local recurrence. CA 19-9 and symptoms appear to be additive prognostic factors - asymptomatic pts with a normal CA 19-9 had a MS of 18 mo (from recurrence) compared to 10mo for those with either CA 19-9 elevation or symptoms and 5 mo when both were observed (p<0.0001). Conclusions: These data suggest that in the majority of pts with resected PC, symptoms and/or CA19-9 elevation precedes or accompanies disease recurrence (85%). Additional analyses evaluating pt variables including neoadjuvant therapy, pathology, PS and response to treatment are underway.