Anti-CA19-9 monoclonal antibody, clone 5F112G13

BackgroundTo evaluate the impact of radiation dose on overall survival (OS) in patients treated with adjuvant chemoradiation (CRT) for pancreatic ductal adenocarcinoma (PDAC).MethodsA multicenter retrospective analysis on 514 patients with PDAC (T1-4; N0-1; M0) treated with surgical resection with macroscopically negative margins (R0-1) followed by adjuvant CRT was performed. Patients were stratified into 4 groups based on radiotherapy doses (group 1: <45Gy, group 2: 45 and<50Gy, group 3: 50 and<55Gy, group 4: 55Gy). Adjuvant chemotherapy was prescribed to 141 patients. Survival functions were plotted using the Kaplan-Meier method and compared through the log-rank test.ResultsMedian follow-up was 35months (range: 3-120months). At univariate analysis, a worse OS was recorded in patients with higher preoperative Ca 19.9 levels (90U/ml; p<0.001), higher tumor grade (G3-4, p=0.004), R1 resection (p=0.004), higher pT stage (pT3-4, p=0.002) and positive nodes (p<0.001). Furthermore, patients receiving increasing doses of CRT showed a significantly improved OS. In groups 1, 2, 3, and 4, median OS was 13.0months, 21.0months, 22.0months, and 28.0months, respectively (p=0.004). The significant impact of higher dose was confirmed by multivariate analysis.ConclusionsIncreasing doses of CRT seems to favorably impact on OS in adjuvant setting. The conflicting results of randomized trials on adjuvant CRT in PDAC could be due to <45Gy dose generally used.

Objectives The LI-RADS M (LR-M) category describes hepatic lesions probably or definitely malignant, but not specific for hepatocellular carcinoma in at-risk patients. Differentiation among LR-M entities, particularly detecting cholangiocarcinoma-containing tumors (M-CCs), is essential for treatment and prognosis. Thus, we aimed to develop diagnostic models on gadoxetate disodium-enhanced MRI comprising serum tumor markers and LI-RADS imaging features for M-CC. Methods Consecutive at-risk patients with LR-M lesions exclusively (no co-existing LR-4 and/or LR-5 lesions) were retrieved retrospectively from a prospectively collected database spanning 3 years. Intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular-cholangiocarcinoma (c-HCC-CCA) were classified together as M-CC. LI-RADS features determined by three independent radiologists and clinically relevant serum tumor markers were used to generate M-CC diagnostic models through logistic regression analysis against histology. Per-patient performance was evaluated using area under the receiver operating curve (AUC), sensitivity, and specificity. Results Forty-five patients were included, 42.2% (19/45) with hepatocellular carcinoma, 33.3% (15/45) with ICC, 13.3% (6/45) with c-HCC-CCA, and 11.1% (5/45) with other hepatic lesions. Carbohydrate antigen (CA)19-9 > 38 U/mL, alpha-fetoprotein (AFP) > 4.8 ng/mL, and absence of the LI-RADS feature "blood products in mass" were significant predictors of M-CC. Combining three predictors demonstrated AUC of 0.862, sensitivity of 76%, and specificity of 88%. The risk of M-CC with all three criteria fulfilled was 98% (AUC, 0.690; sensitivity, 38%; specificity, 100%). Conclusions In at-risk patients with LR-M lesions, integrating CA19-9, AFP, and the LI-RADS feature "blood products in mass" achieved high diagnostic performance for M-CC. When all three criteria were fulfilled, the specificity for M-CC was 100%.