Preoperative Biomarker Panel With Fibrinogen, FVIII, and CA 19–9 as a Tool for Prognostic Evaluation in Neoadjuvant‐Treated Pancreatic Ductal Adenocarcinoma

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is highly thrombogenic and lethal, with rising incidence. Combining carbohydrate antigen (CA) 19-9, fibrinogen, coagulation factor VIII (FVIII), albumin, and alkaline phosphatase (ALP) as a diagnostic panel improves diagnostics. We evaluated the prognostic value of this panel in neoadjuvant therapy (NAT) and upfront surgery (US) treated patients undergoing radical-intent surgery. METHODS: PDAC patients undergoing radical-intent surgery with available preoperative coagulation variables were included (n = 205). Patients with borderline resectable tumors received NAT (n = 76). The diagnostic panel and a modified panel including only fibrinogen, FVIII, and CA 19-9 were assessed preoperatively and evaluated for disease-specific and disease-free survival (DSS and DFS, respectively). Follow-up was for at least two years or until earlier death. RESULTS: Preoperative fibrinogen was higher in the US-treated PDAC patients (US PDAC) than in the NAT-treated PDAC patients (NAT PDAC) (p < 0.001). Elevated fibrinogen, FVIII, and CA 19-9 predicted poor DSS individually and as a panel among NAT PDAC; a low modified panel score was associated with better DSS than higher panel scores (HR 7.8, 95% CI 1.7-36.1, p = 0.009). CONCLUSIONS: Preoperatively elevated fibrinogen and FVIII indicated a worse prognosis among NAT patients, especially when combined with CA 19-9 in a panel, possibly referring to treatment response after NAT. Further studies should assess whether preoperative dampening of coagulation activity would improve survival.