Background: The objective of this study was to investigate the optimal neoadjuvant therapy (NAT) for borderline resectable pancreatic cancer invading the portal vein (BR-PV) or abutting major arteries (BR-A). Methods: We retrospectively analyzed 88 patients with BR-PV and 111 patients with BR-A. Results: In BR-PV patients who underwent upfront surgery (n = 46)/NAT (n = 42), survival was significantly better in the NAT group (3-year overall survival (OS): 5.8%/35.5%, p = 0.004). In BR-A patients who underwent upfront surgery (n = 48)/NAT (n = 63), survival was also significantly better in the NAT group (3-year OS:15.5%/41.7%, p < 0.001). The prognosis tended to be better in patients who received newer chemotherapeutic regimens, such as FOLFIRINOX and gemcitabine with nab-paclitaxel. In 36 BR-PV patients who underwent surgery after NAT, univariate analysis revealed that normalization of tumor marker (TM) levels (p = 0.028) and preoperative high prognostic nutritional index (PNI) (p = 0.022) were significantly associated with a favorable prognosis. In 39 BR-A patients who underwent surgery after NAT, multivariate analysis revealed that preoperative PNI > 42.5 was an independent prognostic factor (HR: 0.15, p = 0.014). Conclusions: NAT using newer chemotherapy is essential for improving the prognosis of BR pancreatic cancer. These findings suggest that prognosis may be prolonged by maintaining good nutritional status during preoperative treatment.
Background
In pancreatic ductal adenocarcinoma (PDAC), only radical surgery improves long‐term survival. We focused on surgical outcome after induction gemcitabine along with nab‐paclitaxel (GnP) and subsequent chemoradiotherapy (CRT) with S‐1 administration for unresectable locally advanced (UR‐LA) PDAC.
Methods
We retrospectively analyzed 144 patients with UR‐LA PDAC between 2014 and 2020. The first‐line regimen of induction chemotherapy was GnP for 125 of the 144 patients. Of the 125 patients who received GnP, 41 who underwent radical resection after additional preoperative CRT were enrolled. We evaluated the prognostic factors for this treatment strategy.
Results
The median length of preoperative GnP was 8.8 months, and 30 (73%) patients had normalized CA19‐9 levels. R0 resection was achieved in 36 (88%) patients. Postoperative major complications of ≥Clavien–Dindo grade IIIa developed in 16 (39%) patients. With a median follow‐up of 35.2 months, 14 (34%) patients developed distant metastasis postoperatively. Using the Kaplan–Meier method, prognostic analysis of the 41 cases revealed the 3‐y overall survival rate (OS) was 77.4% and the 5‐y OS was 58.6%. In univariate analysis, length of preoperative GnP (≥8 months), CA19‐9 normalization, and good nutritional status at operation (prognostic nutritional index ≥41.7) were significantly associated with favorable prognosis. Multivariate analysis revealed CA19‐9 normalization (hazard ratio [HR] 0.23; P = .032) and prognostic nutritional index ≥41.7 (HR 0.05; P = .021) were independent prognostic factors.
Conclusion
For surgical outcome after induction GnP and subsequent CRT for UR‐LA PDAC, CA19‐9 normalization and maintenance of good nutritional status during treatment until surgery were important for prolonged prognosis.
A 55-year-old woman, who had systemic amyloidosis associated with multiple myeloma, had sudden development of hematomasof her lip and upper eye lid. There was no evidence of deterioration of multiple myeloma, thrombocytopenia nor deficiency of coagulation factors. Biopsy specimen showed the deposit of amyloid substance in the dermis and perivascular region. The bleeding tendency in this patient with myeloma was likely due to the deposit of amyloid substance in the vascular wall; improvementwas achieved with administration of hemostatic agents. (Internal Medicine 32: 879-881, 1993)
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