Is the combined use of CA19-9 and DUPAN-2 useful in both pancreatic head and body and tail cancers?

This study investigated the clinical utility of the combined use of preoperative carbohydrate antigen (CA) 19 − 9 and Duke pancreatic monoclonal antigen type 2 (DUPAN-2) in patients with pancreatic head (Ph) and body and tail (Pbt) cancers. This study included patients who underwent curative-intent surgery for pancreatic ductal adenocarcinoma, and were divided into Ph and Pbt groups. They were further subdivided into four groups according to their CA19-9 and DUPAN-2 levels: normal CA19-9/normal DUPAN-2 (N/N), normal CA19-9/high DUPAN-2 (N/H), high CA19-9/normal DUPAN-2 (H/N), and high CA19-9/high DUPAN-2 (H/H). Of 547 patients, 352 had Ph cancer (Ph group) and 195 had Pbt cancer (Pbt group). In the Ph group, the 5-year survival rates in the N/N, N/H, H/N, and H/H groups were 65.4%, 36.6%, 33.1%, and 29.9%, respectively. In the Pbt group, those rates were 70.3%, 30.8%, 45.9%, and 45.4%, respectively. The survival rates in the N/N group were significantly higher than those in the other three groups in both Ph group (P < 0.001, P = 0.002, and P < 0.001, respectively) and Pbt group (P = 0.002, P = 0.003, and P = 0.004, respectively). Multivariate analysis identified the N/N group as an independent favorable prognostic factorfor OS in both Ph and Pbt groups (p < 0.001 and p = 0.002, respectively). Only patients with normal CA19-9 and DUPAN-2 levels had significantly improved survival in both Ph and Pbt groups.