# ASO Author Reflections: Carcinoembryonic Antigen as a Predictor of Failure to Reach Surgery in Patients with Borderline Resectable Pancreatic Cancer Undergoing Neoadjuvant Therapy

## TL;DR

High levels of carcinoembryonic antigen predict whether patients with borderline resectable pancreatic cancer will not reach surgery after neoadjuvant therapy.

## Contribution

Identifies carcinoembryonic antigen as a novel biomarker for predicting treatment outcomes in borderline resectable pancreatic cancer.

## Key findings

- Elevated baseline carcinoembryonic antigen is an independent predictor of failure to reach surgery.
- Failure to reach surgery is primarily due to local tumor progression in these patients.
- CEA can guide treatment decisions between neoadjuvant therapy and upfront surgery.

## Abstract

Borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) presents a therapeutic challenge, balancing the benefits of neoadjuvant therapy (NT) against the risk of missing the opportunity for cure by upfront surgery. In this retrospective study, we evaluated real-world outcomes in patients with BR-PDAC undergoing NT and identified elevated baseline carcinoembryonic antigen (CEA) as an independent predictor of failure to reach surgery, primarily due to local tumor progression. Our findings suggest that CEA may serve as a practical biomarker to guide treatment selection between NT and upfront surgery.