Nathalie Rosumeck1, Lea Timmermann2, Fritz Klein2, Marcus Bahra2, Sebastian Stintzig1, Thomas Malinka2, Uwe Pelzer1. 1. Department of Hematology/Oncology/Tumorimmunology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Institute of Health, 10117 Berlin, Germany. 2. Department of Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Institute of Health, 10117 Berlin, Germany.
Abstract
Background and Objectives: An increasing number of patients (pts) with locally advanced pancreatic cancer (LAPC) are treated with an intensive neoadjuvant therapy to obtain a secondary curative resection. Only a certain number of patients benefit from this intention. The aim of this investigation was to identify prognostic factors which may predict a benefit for secondary resection. Materials and Methods: Survival time and clinicopathological data of pts with pancreatic cancer were prospective and consecutively collected in our Comprehensive Cancer Center Database. For this investigation, we screened for pts with primarily unresectable pancreatic cancer who underwent a secondary resection after receiving induction therapy in the time between March 2017 and May 2019. Results: 40 pts had a sufficient database to carry out a reliable analysis. The carbohydrate-antigen 19-9 (CA 19-9) level of the pts treated with induction therapy decreased by 44.7% from 4358.3 U/mL to 138.5 U/mL (p = 0.001). The local cancer extension was significantly reduced (p < 0.001), and the Eastern Cooperative Oncology Group (ECOG) performance status was lowered (p = 0.03). The median overall survival (mOS) was 20 months (95% CI: 17.2-22.9). Pts who showed a normal CA 19-9 level (<37 U/mL) at diagnosis and after neoadjuvant therapy or had a Body Mass Index (BMI) below 25 kg/m2 after chemotherapy had a significant prolonged overall survival (29 vs. 19 months, p = 0.02; 26 vs. 18 months, p = 0.04; 15 vs. 24 months, p = 0.01). Pts who still presented elevated CA 19-9 levels >400 U/mL after induction therapy did not profit from a secondary resection (24 vs. 7 months, p < 0.001). Nodal negativity as well as the performance of an adjuvant therapy lead to better mOS (25 vs. 15 months, p = 0.003; 10 vs. 25 months, p < 0.001). Conclusion: The pts in our investigation had different benefits from the multimodal treatment. We identified the CA 19-9 level at time of diagnosis and after neoadjuvant therapy as well as the preoperative BMI as predictive factors for overall survival. Furthermore, diagnostics of presurgical nodal status should gain more importance as nodal negativity is associated with better outcome.
Background and Objectives: An increasing number of patients (pts) with locally advanced pancreatic cancer (LAPC) are treated with an intensive neoadjuvant therapy to obtain a secondary curative resection. Only a certain number of patients benefit from this intention. The aim of this investigation was to identify prognostic factors which may predict a benefit for secondary resection. Materials and Methods: Survival time and clinicopathological data of pts with pancreatic cancer were prospective and consecutively collected in our Comprehensive Cancer Center Database. For this investigation, we screened for pts with primarily unresectable pancreatic cancer who underwent a secondary resection after receiving induction therapy in the time between March 2017 and May 2019. Results: 40 pts had a sufficient database to carry out a reliable analysis. The carbohydrate-antigen 19-9 (CA 19-9) level of the pts treated with induction therapy decreased by 44.7% from 4358.3 U/mL to 138.5 U/mL (p = 0.001). The local cancer extension was significantly reduced (p < 0.001), and the Eastern Cooperative Oncology Group (ECOG) performance status was lowered (p = 0.03). The median overall survival (mOS) was 20 months (95% CI: 17.2-22.9). Pts who showed a normal CA 19-9 level (<37 U/mL) at diagnosis and after neoadjuvant therapy or had a Body Mass Index (BMI) below 25 kg/m2 after chemotherapy had a significant prolonged overall survival (29 vs. 19 months, p = 0.02; 26 vs. 18 months, p = 0.04; 15 vs. 24 months, p = 0.01). Pts who still presented elevated CA 19-9 levels >400 U/mL after induction therapy did not profit from a secondary resection (24 vs. 7 months, p < 0.001). Nodal negativity as well as the performance of an adjuvant therapy lead to better mOS (25 vs. 15 months, p = 0.003; 10 vs. 25 months, p < 0.001). Conclusion: The pts in our investigation had different benefits from the multimodal treatment. We identified the CA 19-9 level at time of diagnosis and after neoadjuvant therapy as well as the preoperative BMI as predictive factors for overall survival. Furthermore, diagnostics of presurgical nodal status should gain more importance as nodal negativity is associated with better outcome.
Authors: Helmut Oettle; Hanno Riess; Jens M Stieler; Gerhard Heil; Ingo Schwaner; Jörg Seraphin; Martin Görner; Matthias Mölle; Tim F Greten; Volker Lakner; Sven Bischoff; Marianne Sinn; Bernd Dörken; Uwe Pelzer Journal: J Clin Oncol Date: 2014-06-30 Impact factor: 44.544
Authors: Theodoros Michelakos; Ilaria Pergolini; Carlos Fernández-Del Castillo; Kim C Honselmann; Lei Cai; Vikram Deshpande; Jennifer Y Wo; David P Ryan; Jill N Allen; Lawrence S Blaszkowsky; Jeffrey W Clark; Janet E Murphy; Ryan D Nipp; Aparna Parikh; Motaz Qadan; Andrew L Warshaw; Theodore S Hong; Keith D Lillemoe; Cristina R Ferrone Journal: Ann Surg Date: 2019-04 Impact factor: 12.969
Authors: Cristina R Ferrone; Giovanni Marchegiani; Theodore S Hong; David P Ryan; Vikram Deshpande; Erin I McDonnell; Francesco Sabbatino; Daniela Dias Santos; Jill N Allen; Lawrence S Blaszkowsky; Jeffrey W Clark; Jason E Faris; Lipika Goyal; Eunice L Kwak; Janet E Murphy; David T Ting; Jennifer Y Wo; Andrew X Zhu; Andrew L Warshaw; Keith D Lillemoe; Carlos Fernández-del Castillo Journal: Ann Surg Date: 2015-01 Impact factor: 12.969
Authors: Mark J Truty; Michael L Kendrick; David M Nagorney; Rory L Smoot; Sean P Cleary; Rondell P Graham; Ajit H Goenka; Christopher L Hallemeier; Michel G Haddock; William S Harmsen; Amit Mahipal; Robert R McWilliams; Thorvardur R Halfdanarson; Axel F Grothey Journal: Ann Surg Date: 2021-02-01 Impact factor: 13.787
Authors: Ryan K Schmocker; Michael J Wright; Ding Ding; Michael J Beckman; Ammar A Javed; John L Cameron; Kelly J Lafaro; William R Burns; Matthew J Weiss; Jin He; Christopher L Wolfgang; Richard A Burkhart Journal: Ann Surg Oncol Date: 2020-10-13 Impact factor: 4.339