Predictors of Resectability and Survival in Patients With Borderline and Locally Advanced Pancreatic Cancer who Underwent Neoadjuvant Treatment With FOLFIRINOX

Michelakos, Theodoros; Pergolini, Ilaria; Castillo, Carlos Fernández‐del; Honselmann, Kim C.; Cai, Lei; Deshpande, Vikram; Wo, Jennifer Y.; Ryan, David P.; Allen, Jill N.; Blaszkowsky, Lawrence S.; Clark, Jeffrey W.; Murphy, Janet E.; Nipp, Ryan David; Parikh, Aparna R.; Qadan, Motaz; Warshaw, Andrew L.; Hong, Theodore S.; Lillemoe, Keith D.; Ferrone, Cristina R.

doi:10.1097/sla.0000000000002600

Cited by 262 publications

(267 citation statements)

References 23 publications

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“…Generally, an upfront surgical approach has not been justified in patients with UR‐PDAC due to the high frequency of mortality and morbidity and poor prognosis. Conversion surgery provided favorable outcomes of a high proportion of margin‐negative resection and negative lymph node metastasis, resulting in improved MST ranging from 19.5 to 64 months in patients with initial UR‐PDAC . When patients were selected after a favorable response to anticancer treatment followed by conversion surgery, MST did not seem to differ according to resectability status.…”

Section: Discussionmentioning

confidence: 99%

Surgical indication for and desirable outcomes of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma

Satoi

Yamamoto

Yamaki

et al. 2019

Annals of Gastroent Surgery

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Aim of this review is to propose an acceptable surgical indication for conversion surgery in patients with initially unresectable (UR) pancreatic ductal adenocarcinoma (PDAC) by considering desirable outcomes, including resectability, overall survival (OS), and disease-free survival (DFS). A comprehensive literature search of PubMed was conducted through July 15, 2019. Eligible studies were those reporting on patients with UR-PDAC who underwent surgery. We excluded case reports with fewer than 10 patients, insufficient descriptions of survival data, and palliative surgery.When patients with UR-PDAC with no progression after chemo(radiation) therapy were offered surgical exploration, resectability and median survival time (MST) of those who underwent conversion surgery ranged from 20% to 69% (median, 52%) and from 19.5 to 33 months (median, 21.9 months), respectively. When conversion surgery was carried out in patients with expected margin-negative resection or with clinical response by Response Evaluation Criteria In Solid Tumors (RECIST), resectability and MST ranged from 18% to 27% (median, 20%) and from 21 to 35.3 months (median, 30 months), respectively. Among patients who underwent conversion surgery based on clinical response and decreased CA19-9 level after multimodal treatment, resectability and MST ranged from 2% to 24% (median, 4.1%) and from 24.1 to 64 months (median, 36 months), respectively. Decreased CA19-9 level was a predictor of resectability, OS and DFS by multivariate analysis. In conclusion, decision-making for conversion surgery based on clinical response and decreased CA19-9 level after multimodal treatment may be appropriate. With regard to desirable outcomes of OS and DFS, conversion surgery may provide improved survival for patients with initial UR-PDAC. K E Y W O R D Sconversion surgery, overall survival, resectability, surgical indication, unresectable pancreatic ductal adenocarcinoma | 7 SATOI eT Al.

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Section: Discussionmentioning

confidence: 99%

Surgical indication for and desirable outcomes of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma

Satoi

Yamamoto

Yamaki

et al. 2019

Annals of Gastroent Surgery

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“…Several studies on CS among patients with UR‐PC have been reported so far . In the most recent meta‐analysis based on reports since 2009, the rate of conversion from UR‐LA disease to surgery was 26% and OS was 18.7 months .…”

Section: Discussionmentioning

confidence: 99%

“…In the most recent meta‐analysis based on reports since 2009, the rate of conversion from UR‐LA disease to surgery was 26% and OS was 18.7 months . Other reports of conversion from initial UR‐PC to radical surgery after favorable response to induction treatment reported a wide range of conversion rates, depending on whether patients with M disease were included . Nitsche et al reported that CS was possible in four (28.6%) of 14 patients with UR‐PC who received FOLFIRINOX as first‐line treatment.…”

Section: Discussionmentioning

confidence: 99%

“…To date, there have been no definitive reports concerning predictive factors for conversion to radical surgery in patients with LA‐PC and M‐PC following induction treatment . Various prognostic factors for OS, on the other hand, have been identified in prospective and retrospective studies .…”

Section: Discussionmentioning

confidence: 99%

“…Choi et al analyzed survival in patients with LA‐PC treated with CRT; they found that the administration of high‐dose radiation (≥61 Gy), maximum standard uptake value on initial PET‐CT (<3.5) with carbohydrate antigen (CA) 19‐9 ≤400 U/mL, and surgical resection after CRT were significantly related to prolonged OS based on multivariate analysis. There is consensus that completion of radical surgery after induction treatment is one of the leading prognostic factors for OS in patients with UR‐PC, irrespective of LA or M status . However, it still remains unclear whether the prolongation of OS resulted from completing surgery or long‐term patient selection during induction CT. Interestingly, MS of patients with minor ascites on MDCT suggestive of latent peritoneal metastasis was shorter in the current multicenter cohort study, suggesting that ascites should be considered before initiating induction treatment for potential UR‐LA‐PC.…”

Section: Discussionmentioning

confidence: 99%

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Clinical usefulness of conversion surgery for unresectable pancreatic cancer diagnosed on multidetector computed tomography imaging: Results from a multicenter observational cohort study by the Hokkaido Pancreatic Cancer Study Group (HOPS UR‐01)

Kimura

Nakamura

Hayashi

et al. 2019

Annals of Gastroent Surgery

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Background and Aim Effective multidisciplinary approaches for unresectable pancreatic cancer (UR‐PC) that include modern chemotherapeutic regimens and subsequent conversion surgery (CS) are being developed. The aim of this study was to evaluate outcomes of patients clinically diagnosed with UR‐PC, focusing on the efficacy of CS. Methods Patients ineligible for two multicenter phase II studies conducted by the Hokkaido Pancreatic Cancer Study Group (HOPS) were recruited. Sequential treatment regimens, conversion to radical surgery, and overall survival (OS) were analyzed by multidetector computed tomography (MDCT)‐based UR factors. Univariate and multivariate analyses were performed to identify predictors of OS. Results Sixty‐six of 247 intended recruits for HOPS studies from October 2013 to April 2016 were included. Unresectability was due to locally advanced (LA) disease and metastasis (M) in 42 and 24 patients, respectively. Induction therapy began with chemotherapy (CT) and chemoradiotherapy (CRT) in 44 and 17 patients, respectively, of whom 23 received modern CT regimens. Radical surgery was completed in 12 (LA, 10; M, two) with a median treatment interval of 10.3 months (range, 2‐32). Eleven patients (91.6%) achieved pathological R0 resection. Median OS was significantly longer in patients who underwent CS than those who did not (44.1 vs 14.5 months, P < 0.0001). CS was an independent predictor of OS (hazard ratio, 0.078; 95% confident interval, 0.017‐0.348; P = 0.001). Conclusion Conversion surgery after a favorable response to sequential treatment might prolong survival in patients with UR‐PC. Precise diagnosis on MDCT followed by sequential multimodal anticancer treatment is essential.

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Evaluation of Adjuvant Chemotherapy in Patients With Resected Pancreatic Cancer After Neoadjuvant FOLFIRINOX Treatment

et al. 2020

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Predictors of Resectability and Survival in Patients With Borderline and Locally Advanced Pancreatic Cancer who Underwent Neoadjuvant Treatment With FOLFIRINOX

Cited by 262 publications

References 23 publications

Surgical indication for and desirable outcomes of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma

Surgical indication for and desirable outcomes of conversion surgery in patients with initially unresectable pancreatic ductal adenocarcinoma

Clinical usefulness of conversion surgery for unresectable pancreatic cancer diagnosed on multidetector computed tomography imaging: Results from a multicenter observational cohort study by the Hokkaido Pancreatic Cancer Study Group (HOPS UR‐01)

Evaluation of Adjuvant Chemotherapy in Patients With Resected Pancreatic Cancer After Neoadjuvant FOLFIRINOX Treatment

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