Association of radiotherapy with favorable prognosis in daily clinical practice for treatment of locally advanced and metastatic pancreatic cancer

Guo, Jhe-Cyuan; Yeh, Kun‐Huei; Tien, Yu‐Wen; Cheng, Ann‐Lii; Kuo, Sung‐Hsin

doi:10.1111/jgh.13395

Cited by 6 publications

(7 citation statements)

References 35 publications

(48 reference statements)

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“…In metastatic pancreatic cancer patients, current studies have demonstrated that FOLFIRINOX, nab-paclitaxel plus gemcitabine, and nanoliposomal irinotecan increased the tumor responses and OS compared to the aforementioned conventional chemotherapy regimens [28,29,30,31,32,33]. In addition, several studies showed that aggressive treatment of an isolated local recurrence with re-resection, chemoradiotherapy, or stereotactic body radiation therapy provides survival benefit to these patients [55,56,57,58]. We believe that the use of a combination of H & P, tests for both tumor makers (CEA and CA19-9), and CT as surveillance can detect the local recurrence or metastases in resected pancreatic cancer patients early, and thus, allow aggressive local therapy and current systemic chemotherapy regimens, which will not only increase PROS (more than our PROS of 7.8 months in the intensive group) but also prolong OS.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Imaging and Tumor Marker Surveillance in Resected Pancreatic Cancer

Guo

Tien

et al. 2019

JCM

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Background: Pancreatic cancer is a catastrophic disease with high recurrence and death rates, even in early stages. Early detection and early treatment improve survival in many cancer types but have not yet been clearly documented to do so in pancreatic cancer. In this study, we assessed the benefit on survival resulting from different patterns of surveillance in daily practice after curative surgery of early pancreatic cancer. Methods: Patients with pancreatic ductal adenocarcinoma who had received curative surgery between January 2000 and December 2013 at our institute were retrospectively reviewed. Patients were classified into one of four groups, based on surveillance strategy: the symptom group, the imaging group, the marker group (carbohydrate antigen 19-9 and/or carcinoembryonic antigen), and the intense group (both imaging and tumor marker assessment). Overall survival (OS), relapse-free survival (RFS), and post-recurrence overall survival (PROS) were evaluated. Results: One hundred and eighty-one patients with documented recurrence or metastasis were included in our analysis. The median OS for patients in the symptom group, imaging group, marker group, and intense group were 21.4 months, 13.9 months, 20.5 months, and 16.5 months, respectively (p = 0.670). Surveillance with imaging, tumor markers, or both was not an independent risk factor for OS in univariate and multivariate analyses. There was no significant difference in median RFS (symptom group, 11.7 months; imaging group, 6.3 months; marker group, 9.3 months; intense group, 6.9 months; p = 0.259) or median PROS (symptom group, 6.9 months; imaging group, 7.5 months; marker group, 5.0 months; intense group, 7.8 months; p = 0.953) between the four groups. Multivariate analyses identified poor Eastern Cooperative Oncology Group Performance Status (ECOG PS) (≥1), primary tumor site (tail), and tumor grade (poor differentiation) were poor prognostic factors for OS. Conclusions: Surveillance with regular imaging, tumor marker, or both was not an independent risk factor for OS of pancreatic cancer patients who undergo curative tumor resection.

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Section: Discussionmentioning

confidence: 99%

Postoperative Imaging and Tumor Marker Surveillance in Resected Pancreatic Cancer

Guo

Tien

et al. 2019

JCM

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“…Due to conventional treatment resistance in PC, new immunotherapeutic strategies are urgently needed. 52 , 53 Immunotherapy with immune checkpoint inhibition has shown promise as a therapeutic approach. 54 PD-L1, a critical immune checkpoint, is the primary PD-1 ligand, and it can decrease cytokine secretion and attenuate the biologic function of PD-1+ cells and tumor-infiltrating CD4 + and CD8 + T-cells.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of PD-L1 overexpression for pancreatic cancer: evidence from a meta-analysis

Zhuansun¹,

Huang²,

Feng³

et al. 2017

OTT

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Programmed death-ligand 1 (PD-L1) is an immune checkpoint that is often activated in cancer and plays a pivotal role in the initiation and progression of cancer. However, the clinicopathologic significance and prognostic value of PD-L1 in pancreatic cancer (PC) remains controversial. In this study, we conducted a meta-analysis to retrospectively evaluate the relationship between PD-L1 and PC. PubMed and other databases were searched for the clinical studies published up to March 21, 2017, to be included in the meta-analysis. Hazard ratios and their 95% CIs were calculated. Risk ratios (RRs) were extracted to assess the correlations between the clinicopathologic parameters and PD-L1 expression. Ten studies including 1,058 patients were included in the meta-analysis. The pooled results indicated that positive PD-L1 expression was correlated with a poor overall survival outcome in PC patients (hazard ratio =1.76, 95% CI: 1.43–2.17, P<0.00001). Interestingly, high PD-L1 expression was correlated with poor pathologic differentiation (RR =1.57, 95% CI: 1.25–1.98, P=0.0001) and neural invasion (RR =1.30, 95% CI: 1.03–1.64, P=0.03). However, there were no significant correlations between PD-L1 expression and other clinicopathologic characteristics. In summary, our meta-analysis implied that PD-L1 could serve as a negative predictor for the overall survival of PC patients, and high expression of PD-L1 was correlated with poor differentiation and neural invasion, indicating that anti-PD-L1 treatments should be evaluated in PC patients, especially in those who exhibit these two characteristics.

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“…In this study, MDM2 was determined to be a prognostic factor for poor prognosis and progression under gemcitabine-based chemotherapy in addition to other poor prognostic factors identified in a previous study, such as old age, poor ECOG PS, high CEA level, and low albumin level [30]. Although it was not clearly linked to any baseline characteristics associated with poor prognosis, MDM2 had borderline significance associated with negative regional lymph node involvement, which is generally a favorable prognostic factor.…”

Section: Discussionmentioning

confidence: 99%

Association of MDM2 expression with shorter progression-free survival and overall survival in patients with advanced pancreatic cancer treated with gemcitabine-based chemotherapy

et al. 2017

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This study evaluated the prognostic roles of murine double minute 2 (MDM2) and p53 in pancreatic cancer patients treated with gemcitabine-based chemotherapy. A total of 137 advanced or recurrent adenocarcinoma patients who were treated with gemcitabine-based palliative chemotherapy were reviewed, selected from 957 patients with pancreatic malignancy between 2008 and 2013 at our hospital. Immunohistochemical staining for MDM2 and p53 with formalin-fixed, paraffin-embedded tumor tissues was independently reviewed. Nuclear or cytoplasmic expression of MDM2 and p53 was found in tumor cells of 30 (21.9%) and 71 (51.8%) patients, respectively. Patients with MDM2 expression had shorter median overall survival (OS) (3.7 vs 5.8 mo; P = .048) and median progression-free survival (PFS) (1.5 vs 2.5 mo; P < .001); by contrast, p53 expression was not correlated with OS or PFS. In the multivariate analysis, MDM2 expression (hazard ratio = 1.731; P = .025) was an independent and unfavorable prognostic factor of OS. Additionally, MDM2 expression was significantly associated with progressive disease (PD) and death (P = .015) following first-line gemcitabine-based therapy. In advanced pancreatic cancer patients, MDM2 expression is associated with shorter OS and PFS after gemcitabine-based chemotherapy.

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Association of radiotherapy with favorable prognosis in daily clinical practice for treatment of locally advanced and metastatic pancreatic cancer

Abstract: The use of RT might be associated with a favorable clinical outcome in patients with locally advanced and metastatic pancreatic cancer. Further exploration of RT as a first-line therapy or second-line therapy for locally advanced or even metastatic pancreatic cancer is warranted.

Cited by 6 publications

References 35 publications

Postoperative Imaging and Tumor Marker Surveillance in Resected Pancreatic Cancer

Postoperative Imaging and Tumor Marker Surveillance in Resected Pancreatic Cancer

Prognostic value of PD-L1 overexpression for pancreatic cancer: evidence from a meta-analysis

Association of MDM2 expression with shorter progression-free survival and overall survival in patients with advanced pancreatic cancer treated with gemcitabine-based chemotherapy

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