Yuichi Nagakawa1, Yatsuka Sahara2, Yuichi Hosokawa2, Yoshiaki Murakami3, Hiroki Yamaue4, Sohei Satoi5, Michiaki Unno6, Shuji Isaji7, Itaru Endo8, Masayuki Sho9, Tsutomu Fujii10, Chie Takishita2, Yosuke Hijikata2, Shuji Suzuki11, Shigeyuki Kawachi12, Kenji Katsumata2, Tetsuo Ohta13, Takukazu Nagakawa13, Akihiko Tsuchida2. 1. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Shinjuku, Tokyo, Japan. naga@tokyo-med.ac.jp. 2. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Shinjuku, Tokyo, Japan. 3. Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. 4. Department of Gastroenterological Surgery, Wakayama Medical University, Wakayama, Japan. 5. Department of Surgery, Kansai Medical University, Moriguchi, Osaka, Japan. 6. Department of Hepatobiliary-Pancreatic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. 7. Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan. 8. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan. 9. Department of Surgery, Nara Medical University, Kashihara, Nara, Japan. 10. Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan. 11. Department of Gastroenterological Surgery, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki, Japan. 12. Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan. 13. Department of Gastroenterological Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan.
Abstract
BACKGROUND: The efficacy of neoadjuvant therapy (NAT), including neoadjuvant chemotherapy (NAC) and neoadjuvant chemo-radiotherapy (NACRT), for patients with borderline resectable pancreatic cancer (BRPC) has not been elucidated. This study aimed to clarify the efficacy of NAC and NACRT for patients with BRPC. METHODS: The study analyzed the treatment outcomes of 884 patients treated for BRPC from 2011 to 2013. Treatment results were compared between upfront surgery and NAT and between NAC and NACRT using propensity score-matching analysis. Overall survival (OS) was calculated via intention-to-treat analyses. RESULTS: The overall resection rates for the patients who underwent NAT were significantly lower than for the patients who underwent upfront surgery (75.1% vs 93.3%; p < 0.001). However, the R0 resection rate was significantly higher for NAT than for upfront surgery (p < 0.001). Additionally, the OS for the patients who received NAT was significantly longer than for those who underwent upfront surgery (median survival time [MST], 25.7 vs 19.0 months; p = 0.015). The lymph node rate for the patients with NACRT was significantly lower than for those who underwent NAC (p < 0.001). However, the resection rate for the NACRT cases was significantly lower than for the NAC cases (p = 0.041). The local recurrence rate for the NACRT cases was significantly lower than for the NAC cases (p = 0.002). However, OS did not differ significantly between NAC and NACRT (MST, 29.2 vs 22.5 months; p = 0.130). CONCLUSIONS: The study showed that NAT has potential benefit for patients with BRPC. Compared with NAC, NACRT decreased the rates for lymph node metastasis and local recurrence but did not improve the prognosis.
BACKGROUND: The efficacy of neoadjuvant therapy (NAT), including neoadjuvant chemotherapy (NAC) and neoadjuvant chemo-radiotherapy (NACRT), for patients with borderline resectable pancreatic cancer (BRPC) has not been elucidated. This study aimed to clarify the efficacy of NAC and NACRT for patients with BRPC. METHODS: The study analyzed the treatment outcomes of 884 patients treated for BRPC from 2011 to 2013. Treatment results were compared between upfront surgery and NAT and between NAC and NACRT using propensity score-matching analysis. Overall survival (OS) was calculated via intention-to-treat analyses. RESULTS: The overall resection rates for the patients who underwent NAT were significantly lower than for the patients who underwent upfront surgery (75.1% vs 93.3%; p < 0.001). However, the R0 resection rate was significantly higher for NAT than for upfront surgery (p < 0.001). Additionally, the OS for the patients who received NAT was significantly longer than for those who underwent upfront surgery (median survival time [MST], 25.7 vs 19.0 months; p = 0.015). The lymph node rate for the patients with NACRT was significantly lower than for those who underwent NAC (p < 0.001). However, the resection rate for the NACRT cases was significantly lower than for the NAC cases (p = 0.041). The local recurrence rate for the NACRT cases was significantly lower than for the NAC cases (p = 0.002). However, OS did not differ significantly between NAC and NACRT (MST, 29.2 vs 22.5 months; p = 0.130). CONCLUSIONS: The study showed that NAT has potential benefit for patients with BRPC. Compared with NAC, NACRT decreased the rates for lymph node metastasis and local recurrence but did not improve the prognosis.
Authors: Asmita Chopra; Mazen Zenati; Melissa E Hogg; Herbert J Zeh; David L Bartlett; Nathan Bahary; Amer H Zureikat; Joal D Beane Journal: Ann Surg Oncol Date: 2021-05-23 Impact factor: 5.344
Authors: Quisette P Janssen; Jacob L van Dam; Laura R Prakash; Deesje Doppenberg; Christopher H Crane; Casper H J van Eijck; Susannah G Ellsworth; William R Jarnagin; Eileen M O'Reilly; Alessandro Paniccia; Marsha Reyngold; Marc G Besselink; Matthew H G Katz; Ching-Wei D Tzeng; Amer H Zureikat; Bas Groot Koerkamp; Alice C Wei Journal: J Natl Compr Canc Netw Date: 2022-07 Impact factor: 12.693
Authors: Asmita Chopra; Jacob C Hodges; Adam Olson; Steve Burton; Susannah G Ellsworth; Nathan Bahary; Aatur D Singhi; Brian A Boone; Joal D Beane; David Bartlett; Kenneth K Lee; Melissa E Hogg; Michael T Lotze; Alessandro Paniccia; Herbert Zeh; Amer H Zureikat Journal: Ann Surg Oncol Date: 2020-11-24 Impact factor: 4.339