New Cancer-Related Symptoms Predict Recurrence in CA19-9 Non-Expressers After Resection of Pancreatic Ductal Adenocarcinoma

Introduction: CA19-9 elevation has been reported to predict recurrence after resection of pancreatic ductal adenocarcinoma (PDAC), although only two-thirds of patients are expressers. Preoperatively, cancer-related symptoms predict outcome; however, it is unknown whether symptoms predict recurrence during surveillance, particularly for CA19-9 non-expressers. Methods: Patients undergoing resection of PDAC at our institution from 2012 to 21 (n = 165) were retrospectively reviewed for CA19-9 and symptoms, which were correlated with recurrence-free survival (RFS). Multivariate analysis was performed using Cox regression. Results: During postoperative surveillance, CA19-9 elevation and development of symptoms (abdominal pain, weight loss, or jaundice) were associated with worse RFS (P <.05). Multivariate analysis showed that both symptoms and CA19-9 were independently predictive of RFS (HR 1.8 [1.1-2.9; P =.025] and 2.5 [1.0-6.0; P =.048]). Among CA19-9 non-expressers (n = 51), development of symptoms was associated with detection of recurrence (P =.012). Conclusions: Among CA19-9 non-expressers, development of symptoms predicted recurrence, providing a useful tool for recurrence detection in these patients.