Knut J Labori1, Matthew H Katz2, Ching W Tzeng3, Bjørn A Bjørnbeth1, Milada Cvancarova4, Bjørn Edwin5,6, Elin H Kure7, Tor J Eide6,8, Svein Dueland9, Trond Buanes1,6, Ivar P Gladhaug1,6. 1. a Department of Hepato-Pancreato-Biliary Surgery , Oslo University Hospital , Oslo , Norway. 2. b Department of Surgical Oncology , The University of Texas MD Anderson Cancer Center , Houston, Texas , USA. 3. c Department of Surgery , University of Kentucky , Lexington, Kentucky , USA. 4. d Department of Oncology , National Resource Center for Late Effects, Oslo University Hospital , Oslo , Norway. 5. e Intervention Centre, Rikshospitalet, Oslo University Hospital , Oslo , Norway. 6. f Institute of Clinical Medicine, University of Oslo , Oslo , Norway. 7. g Department of Genetics , Institute for Cancer Research, Oslo University Hospital , Oslo , Norway. 8. h Department of Pathology , Oslo University Hospital , Oslo , Norway. 9. i Department of Oncology , Oslo University Hospital , Oslo , Norway.
Abstract
BACKGROUND: Multimodality treatment (MMT) improves survival for patients with pancreatic ductal adenocarcinoma (PDAC). The surgery-first (SF) strategy is the most universally accepted approach. MATERIAL AND METHODS: Population-based retrospective cohort study of all cases of resectable PDAC from 2006 to 2012. Patients were planned for adjuvant chemotherapy (AC) with the Nordic 5-fluorouracil/leucovorin regimen. Reasons for and rates of failure to complete AC, postoperative major complications (PMC), and overall survival (OS) were analysed. RESULTS: Of 203 patients, 85 (41.9%) completed AC, 41 (20.2%) failed to complete AC, and 77 (37.9%) never initiated AC. Primary reasons for not initiating or completing AC were early disease progression (34.7%), postoperative complications/poor performance status (32.2%), and age > 75 years (24.6%). Median OS in the whole cohort was 17.0 months, and 20.0 months in patients who initiated AC. Median OS in patients who completed AC was higher than in patients who did not (25.0 months vs. 12.0 months, p < 0.001). PMC (n = 41) were associated with decreased initiation rate (p < 0.001) and completion rate (p = 0.007) of AC, and decreased median OS (11.0 months vs. 19.0 months, p = 0.028). Among patients with R1 resection, PMC again were associated with worse median OS (8.0 months vs. 16.0 months, p = 0.028). Multivariate analysis demonstrated that completion of MMT and tumour grade (G1/G2) were related to mortality rate (p < 0.001). Mortality risk for patients who completed AC was reduced also when adjusting for competing risk (SHR 0.426, p < 0.001). CONCLUSIONS: MMT completion is strongly associated with reduced mortality risk in patients with resectable PDAC undergoing the SF approach. Early disease progression and PMC/poor performance status preclude MMT completion in more than one third of the patients. These reasons for failure to complete MMT underscore the need for strategies to improve patient selection and reduce surgical morbidity in patients with resectable PDAC.
BACKGROUND: Multimodality treatment (MMT) improves survival for patients with pancreatic ductal adenocarcinoma (PDAC). The surgery-first (SF) strategy is the most universally accepted approach. MATERIAL AND METHODS: Population-based retrospective cohort study of all cases of resectable PDAC from 2006 to 2012. Patients were planned for adjuvant chemotherapy (AC) with the Nordic 5-fluorouracil/leucovorin regimen. Reasons for and rates of failure to complete AC, postoperative major complications (PMC), and overall survival (OS) were analysed. RESULTS: Of 203 patients, 85 (41.9%) completed AC, 41 (20.2%) failed to complete AC, and 77 (37.9%) never initiated AC. Primary reasons for not initiating or completing AC were early disease progression (34.7%), postoperative complications/poor performance status (32.2%), and age > 75 years (24.6%). Median OS in the whole cohort was 17.0 months, and 20.0 months in patients who initiated AC. Median OS in patients who completed AC was higher than in patients who did not (25.0 months vs. 12.0 months, p < 0.001). PMC (n = 41) were associated with decreased initiation rate (p < 0.001) and completion rate (p = 0.007) of AC, and decreased median OS (11.0 months vs. 19.0 months, p = 0.028). Among patients with R1 resection, PMC again were associated with worse median OS (8.0 months vs. 16.0 months, p = 0.028). Multivariate analysis demonstrated that completion of MMT and tumour grade (G1/G2) were related to mortality rate (p < 0.001). Mortality risk for patients who completed AC was reduced also when adjusting for competing risk (SHR 0.426, p < 0.001). CONCLUSIONS: MMT completion is strongly associated with reduced mortality risk in patients with resectable PDAC undergoing the SF approach. Early disease progression and PMC/poor performance status preclude MMT completion in more than one third of the patients. These reasons for failure to complete MMT underscore the need for strategies to improve patient selection and reduce surgical morbidity in patients with resectable PDAC.
Authors: Susanna W L de Geus; Gyulnara G Kasumova; Mariam F Eskander; Sing Chau Ng; Tara S Kent; A James Moser; Alexander L Vahrmeijer; Mark P Callery; Jennifer F Tseng Journal: J Gastrointest Surg Date: 2017-10-04 Impact factor: 3.452
Authors: Alice C Wei; Fang-Shu Ou; Qian Shi; Xiomara Carrero; Eileen M O'Reilly; Jeffrey Meyerhardt; Robert A Wolff; Hedy L Kindler; Douglas B Evans; Vikram Deshpande; Joseph Misdraji; Eric Tamm; Dushyant Sahani; Malcolm Moore; Elliot Newman; Nipun Merchant; Jordan Berlin; Laura W Goff; Peter Pisters; Mitchell C Posner Journal: Ann Surg Oncol Date: 2019-08-15 Impact factor: 5.344
Authors: Hao Liu; Mazen S Zenati; Caroline J Rieser; Amr Al-Abbas; Kenneth K Lee; Aatur D Singhi; Nathan Bahary; Melissa E Hogg; Herbert J Zeh; Amer H Zureikat Journal: Ann Surg Oncol Date: 2020-04-22 Impact factor: 5.344
Authors: Iman M Ahmad; Alicia J Dafferner; Kelly A O'Connell; Kamiya Mehla; Bradley E Britigan; Michael A Hollingsworth; Maher Y Abdalla Journal: Cancers (Basel) Date: 2021-05-08 Impact factor: 6.639