Common Hepatic Artery Abutment or Encasement Is an Adverse Prognostic Factor in Patients with Borderline and Unresectable Pancreatic Cancer

Kozak, Geoffrey M.; Epstein, Jeffrey D.; Deshmukh, Sandeep; Scott, Benjamin B.; Keith, Scott W.; Lavu, Harish; Yeo, Charles J.; Winter, Jordan M.

doi:10.1007/s11605-017-3595-7

Cited by 6 publications

(6 citation statements)

References 38 publications

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“…[15] Accordingly, a better prognosis was reported when radiographic signs of CHA involvement were absent. [13] However, the available evidence on the prognostic factors for resection in BR-PDAC patients is scarce, and the majority of studies conducted until now calculate their resection rates over the number of patients that undergo exploratory surgery. We believe this study will provide valuable information on these prognostic factors associated with resection and, unlike previous studies, it will obtain the resection rate by dividing the total number of resections performed by the total number of patients who received ≥ 3 cycles of NAT.…”

Section: Discussionmentioning

confidence: 99%

“…[15] Accordingly, a better prognosis was reported when radiographic signs of CHA involvement were absent. [13]…”

Section: Discussionmentioning

confidence: 99%

“…[11] Other authors suggest that a lower Eastern Cooperative Oncology Group performance status and tumor location in the pancreatic neck have higher resection possibilities, [12] whereas BR-PDACs with significant vascular contact have a worse prognosis. [13][14][15] This study has 2 working hypotheses: i. In type A BR-PDAC patients who received NAT, CA 19-9 plasmatic levels and the tumor anatomical relationship with neighboring vascular structures are prognostic factors for resection.…”

Section: Background and Rationalementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictive factors for resection and survival in type A borderline resectable pancreatic ductal adenocarcinoma patients after neoadjuvant therapy: A retrospective cohort study

et al. 2022

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Introduction: Pancreatic cancer is the seventh leading cause of cancer-related death worldwide, and surgical resection with radical intent remains the only potentially curative treatment option today. However, borderline resectable pancreatic ductal adenocarcinomas (BR-PDAC) stand in the gray area between the resectable and unresectable disease since they are technically resectable but have a high probability of incomplete exeresis. Neoadjuvant treatment (NAT) plays an important role in ensuring resection success. Different survival prognostic factors for BR-PDAC have been well described, but evidence on the predictive factors associated with resection after NAT is scarce. This study aims to study if CA 19-9 plasmatic levels and the tumor anatomical relationship with neighboring vascular structures are prognostic factors for resection and survival (both Overall Survival and Progression-Free Survival) in patients with type A BR-PDAC. Methods: This will be a retrospective cohort study using data from type A BR-PDAC patients who received NAT in the Bellvitge University Hospital. The observation period is from January 2010 until December 2019; patients must have a minimum 12-month follow-up. Patients will be classified according to the MD Anderson Cancer Center criteria for BR-PDAC. Discussion: Patients with BR-PDAC have a high risk for a margin-positive resection. Serum Carbohydrate Antigen 19-9 plasmatic levels and vascular involvement stand out as disease-related prognostic factors. This study will provide valuable information on the prognostic factors associated with resection. We will exclude locally advanced tumors and expect this approach to provide more realistic resection rates without selecting those patients that undergo surgical exploration. However, focusing on an anatomical definition may limit the results’ generalizability.

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Section: Discussionmentioning

confidence: 99%

“…[15] Accordingly, a better prognosis was reported when radiographic signs of CHA involvement were absent. [13]…”

Section: Discussionmentioning

confidence: 99%

Section: Background and Rationalementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Predictive factors for resection and survival in type A borderline resectable pancreatic ductal adenocarcinoma patients after neoadjuvant therapy: A retrospective cohort study

et al. 2022

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“…Involvement of the CHA was also common in the studied cohort. For most patients, isolation of the CHA proximal to GDA was possible, since true invasion by the tumor is uncommon and a dissection plane can be identified 27 – 29 .…”

Section: Discussionmentioning

confidence: 99%

Anatomic Criteria Determine Resectability in Locally Advanced Pancreatic Cancer

et al. 2021

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Background: The introduction of multi-agent chemotherapy and radiation therapy has facilitated potential resection with curative intent in selected LAPC patients with excellent outcomes. Nevertheless, there remains a remarkable lack of consensus on the management of LAPC. We sought to describe the outcomes of patients with LAPC and objectively define the multidisciplinary selection process for operative exploration based on anatomical factors. Methods: Consecutive patients with LAPC were evaluated in the multidisciplinary clinic of a high-volume institution for pancreatic surgery between 2013 and 2018. Prospective stratification (LAPC-1, LAPC-2, and LAPC-3), based on the involvement of regional anatomical structures, was performed at the time of presentation prior to initiation of treatment. Resection rates and patient outcomes were evaluated and correlated with initial anatomic stratification system. Results: Overall, 415 patients with LAPC were included in the study, of whom 84 (20%) were successfully resected with a median overall survival of 35.3 months. The likelihood of operative exploration was associated with the pre-treatment anatomic LAPC score with a resection rate of 49% in patients classified as LAPC-1, 32% in LAPC-2, and 11% in LAPC-3 ( p <0.001). Resected patients with improvement of the LAPC score at the time of exploration had significantly longer median overall survival as compared to those with no change or progression of LAPC score (60.7 vs 29.8 months, p =0.006). Conclusions: Selected patients with LAPC can undergo curative-intent surgery with excellent outcomes. The proposed Johns Hopkins anatomic LAPC score provides an objective system to anticipate the probability of eventual surgical resection after induction therapy.

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Preoperative CT predictors of survival in patients with pancreatic ductal adenocarcinoma undergoing curative intent surgery

et al. 2020

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Common Hepatic Artery Abutment or Encasement Is an Adverse Prognostic Factor in Patients with Borderline and Unresectable Pancreatic Cancer

Abstract: In this cohort, common hepatic arterial abutment or encasement and residual lymph node disease at resection portended a particularly poor outcome in patients with localized, unresectable PDA.

Cited by 6 publications

References 38 publications

Predictive factors for resection and survival in type A borderline resectable pancreatic ductal adenocarcinoma patients after neoadjuvant therapy: A retrospective cohort study

Predictive factors for resection and survival in type A borderline resectable pancreatic ductal adenocarcinoma patients after neoadjuvant therapy: A retrospective cohort study

Anatomic Criteria Determine Resectability in Locally Advanced Pancreatic Cancer

Preoperative CT predictors of survival in patients with pancreatic ductal adenocarcinoma undergoing curative intent surgery

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