Hiroshi Kurahara1, Hiroyuki Shinchi2, Takao Ohtsuka3, Yoshihiro Miyasaka3, Taketo Matsunaga4, Hirokazu Noshiro4, Tomohiko Adachi5, Susumu Eguchi5, Naoya Imamura6, Atsushi Nanashima6, Kazuhiko Sakamoto7, Hiroaki Nagano7, Masayuki Ohta8, Masafumi Inomata8, Akira Chikamoto9, Hideo Baba9, Yusuke Watanabe10, Kazuyoshi Nishihara10, Masafumi Yasunaga11, Koji Okuda11, Shoji Natsugoe2, Masafumi Nakamura3. 1. Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan. h-krhr@m3.kufm.kagoshima-u.ac.jp. 2. Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan. 3. Surgery and Oncology, Kyushu University, Fukuoka, 812-8582, Japan. 4. Surgery, Saga University, Saga, 849-8501, Japan. 5. Surgery, Nagasaki University, Nagasaki, 852-8501, Japan. 6. Hepato-Biliary-Pancreas Surgery, Miyazaki University, Miyazaki, 889-1692, Japan. 7. Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University, Yamaguchi, Japan. 8. Gastroenterological and Pediatric Surgery, Oita University, Oita, 879-5593, Japan. 9. Gastroenterological Surgery, Kumamoto University, Kumamoto, 860-0811, Japan. 10. Surgery, Kitakyushu Municipal Medical Center, Fukuoka, 802-0077, Japan. 11. Gastroenterological Surgery, Department of Medicine, Kurume University, Kurume, 830-0011, Japan.
Abstract
PURPOSE: Neoadjuvant therapy (NAT) is increasingly used to improve the prognosis of patients with borderline resectable pancreatic cancer (BRPC) albeit with little evidence of its advantage over upfront surgical resection. We analyzed the prognostic impact of NAT on patients with BRPC in a multicenter retrospective study. METHODS: Medical data of 165 consecutive patients who underwent treatment for BRPC between January 2010 and December 2014 were collected from ten institutions. We defined BRPC according to the National Comprehensive Cancer Network guidelines, and subclassified patients according to venous invasion alone (BR-PV) and arterial invasion (BR-A). RESULTS: The rates of NAT administration and resection were 35% and 79%, respectively. There were no significant differences in resection rates and prognoses between patients in the BR-PV and BR-A subgroups. NAT did not have a significant impact on prognosis according to intention-to-treat analysis. However, in patients who underwent surgical resection, NAT was independently associated with longer overall survival (OS). The median OS of patients who underwent resection after NAT (53.7 months) was significantly longer than that of patients who underwent upfront (17.8 months) or no resection (14.9 months). The rates of superior mesenteric or portal vein invasion, lymphatic invasion, venous invasion, and lymph node metastasis were significantly lower in patients who underwent resection after NAT than in those who underwent upfront resection despite similar baseline clinical profiles. CONCLUSIONS: Resection after NAT in patients with BRPC is associated with longer OS and lower rates of both invasion to the surrounding tissues and lymph node metastasis.
PURPOSE: Neoadjuvant therapy (NAT) is increasingly used to improve the prognosis of patients with borderline resectable pancreatic cancer (BRPC) albeit with little evidence of its advantage over upfront surgical resection. We analyzed the prognostic impact of NAT on patients with BRPC in a multicenter retrospective study. METHODS: Medical data of 165 consecutive patients who underwent treatment for BRPC between January 2010 and December 2014 were collected from ten institutions. We defined BRPC according to the National Comprehensive Cancer Network guidelines, and subclassified patients according to venous invasion alone (BR-PV) and arterial invasion (BR-A). RESULTS: The rates of NAT administration and resection were 35% and 79%, respectively. There were no significant differences in resection rates and prognoses between patients in the BR-PV and BR-A subgroups. NAT did not have a significant impact on prognosis according to intention-to-treat analysis. However, in patients who underwent surgical resection, NAT was independently associated with longer overall survival (OS). The median OS of patients who underwent resection after NAT (53.7 months) was significantly longer than that of patients who underwent upfront (17.8 months) or no resection (14.9 months). The rates of superior mesenteric or portal vein invasion, lymphatic invasion, venous invasion, and lymph node metastasis were significantly lower in patients who underwent resection after NAT than in those who underwent upfront resection despite similar baseline clinical profiles. CONCLUSIONS: Resection after NAT in patients with BRPC is associated with longer OS and lower rates of both invasion to the surrounding tissues and lymph node metastasis.
Authors: Dany Barrak; Anthony M Villano; Nicole Villafane-Ferriol; Leah G Stockton; Maureen V Hill; Mengying Deng; Elizabeth A Handorf; Sanjay S Reddy Journal: Eur J Surg Oncol Date: 2022-01-05 Impact factor: 4.037