| 論文種別 | 原著(症例報告除く) |
| 言語種別 | 英語 |
| 査読の有無 | その他(不明) |
| 表題 | Duke Pancreatic Monoclonal Antigen Type 2 for Monitoring Carbohydrate Antigen 19-9 Nonexpressor Pancreatic Cancer. |
| 掲載誌名 | 正式名：JAMA surgery 略 称：JAMA Surg ISSNコード：21686262/21686254 |
| 掲載区分 | 国外 |
| 巻・号・頁 | pp.Online ahead of print |
| 著者・共著者 | Kojiro Omiya, Atsushi Oba, Kimitaka Tanaka, Naoki Miyazaki, Shimpei Otsuka, Katsuhisa Ohgi, Teiichi Sugiura, Ryuta Shintakuya, Kenjiro Okada, Kenichiro Uemura, So Yamaki, Daisuke Hashimoto, Koetsu Inoue, Masamichi Mizuma, Michiaki Unno, Nobuhiko Nakagawa, Haruyoshi Tanaka, Hideki Takami, Shintaro Takeuchi, Akira Ito, Keiichi Akahoshi, Daisuke Ban, Shuichiro Sugawara, Ryosuke Takahashi, Fuyuhiko Motoi, Yosuke Inoue, Yu Takahashi, Satoshi Hirano, Sohei Satoi |
| 発行年月 | 2026/06 |
| 概要 | IMPORTANCE:Approximately 5% to 10% of patients with pancreatic cancer are carbohydrate antigen 19-9 (CA 19-9) nonexpressors (≤2 U/mL), predominantly due to the Lewis-negative phenotype, leaving them without established biomarkers for treatment monitoring despite the central role of biomarker assessment in modern pancreatic cancer management.OBJECTIVE:To evaluate Duke pancreatic monoclonal antigen type 2 (DUPAN-2) as a surrogate biomarker for monitoring treatment response in patients with CA 19-9 nonexpressor pancreatic cancer.DESIGN, SETTING, AND PARTICIPANTS:This cohort study included patients with resected pancreatic ductal adenocarcinoma from 9 Japanese academic centers between January 1, 2013, and December 31, 2019. Patients were classified as CA 19-9 nonexpressors (≤2 U/mL) or expressors (>2 U/mL). Median (IQR) follow-up was 55.3 (38.5-74.1) months for expressors and 51.1 (39.3-72.4) months for nonexpressors. Two analysis cohorts were defined among nonexpressors: those with postneoadjuvant DUPAN-2 measurements and those with postresection DUPAN-2 measurements. Data were analyzed from July 2024 to February 2026.EXPOSURES:DUPAN-2 levels after neoadjuvant therapy and after resection, with normal levels defined as ≤150 U/mL.MAIN OUTCOMES AND MEASURES:Overall survival (OS) and disease-free survival (DFS) calculated from the date of resection.RESULTS:Among 2418 patients (median [IQR] age, 70 [63-76] years; 1404 [58.1%] male), 185 (7.7%) were CA 19-9 nonexpressors and 2233 (92.3%) were expressors. Nonexpressors and expressors showed comparable OS (adjusted hazard ratio [HR], 1.10; 95% CI, 0.89-1.37). DUPAN-2 dynamics in nonexpressors mirrored CA 19-9 patterns in expressors, with comparable median (IQR) reductions (postneoadjuvant: -64.5% [-82.2 to -37.2] vs -67.1% [-89.0 to -25.9]; postresection: -71.4% [-84.4 to -48.8] vs -73.4% [-90.7 to -35.4]). Achieving normal DUPAN-2 levels (≤150 U/mL) after neoadjuvant therapy was associated with improved OS (adjusted HR, 0.26; 95% CI, 0.07-0.93) and DFS (adjusted HR, 0.15; 95% CI, 0.04-0.53). Similarly, normal postresection DUPAN-2 was associated with better OS (adjusted HR, 0.18; 95% CI, 0.06-0.55) and DFS (adjusted HR, 0.23; 95% CI, 0.08-0.64).CONCLUSIONS AND RELEVANCE:In this cohort study, DUPAN-2 served as an effective surrogate biomarker for patients with CA 19-9 nonexpressor pancreatic cancer, with normal posttreatment levels associated with favorable outcomes. These findings suggest that routine DUPAN-2 monitoring may enable biomarker-guided treatment decisions for this previously unassessable subgroup. |
| DOI | 10.1001/jamasurg.2026.1810 |
| PMID | 42234435 |