Current Concepts in the Treatment of Resectable Pancreatic Cancer

Roth, Megan; Berlin, Jordan

doi:10.1007/s11912-018-0685-y

Cited by 21 publications

(15 citation statements)

References 29 publications

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“…To achieve this, we should know the most common prognostic factors that may affect the outcome of these patients with PDAC and liable for curative resection. 2,11,12 Our overall postoperative complications were 70.2%, but it was mainly minor complications 49%, like wound infection and grade A DGE, which were within range as demonstrated in different studies. 13,14 Some studies identified that tumor-associated biological properties like tumor diameter, LNs status, and histopathological grading are the most important prognostic factors in PDAC as most of the other tumors.…”

Section: Discussionsupporting

confidence: 81%

Prognostic factors following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Zakaria¹,

Mohamed²,

Alsebaey³

et al. 2018

Int Surg J

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Background: Pancreatic ductal adenocarcinoma (PDAC) had a poor prognosis and surgical resection remains the only potentially curative treatment. The aim of the study was to identify the outcome and risk factors affecting survival after pancreaticoduodenectomy (PD) for PDAC.Methods: The patients who underwent PD for PDAC from 2007 to 2015 were retrospectively studied. Cox regression test for multivariate analysis was used for evaluation of prognostic factors for survival.Results: Ninety-four patients underwent PD for PDAC, 20 patients (21.3%) had major postoperative complications. The perioperative mortality was 4.3%. The 1-, 3-, and 5-years survival rates were 74.5%, 38.7%, 23.4, respectively. In univariate analysis the risk factors for survival were; presence of co-morbidity (P=0.03), high preoperative carbohydrate antigen (CA)19-9 > 400U/ml (P=0.02), advanced tumor stage (P=0.03), large tumor diameter >3cm (P=0.01), poorly differentiated tumor (P= 0.02), involved resection margin (P=0.04), and positive lymph nodes in pathology after surgery (P=0.03). In multivariate analysis the independent risk factors for survival were; high preoperative CA 19-9 (P=0.042), tumor size >3cm (P=0.038), poorly differentiated tumor in histopathology (P=0.045).Conclusions: High tumor marker CA19-9, tumor size, and grade are significant risk factors for poor survival after resection of PDAC and should be taken into account in the selection of patients for surgery to improve the outcome.

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Section: Discussionsupporting

confidence: 81%

Prognostic factors following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Zakaria¹,

Mohamed²,

Alsebaey³

et al. 2018

Int Surg J

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“…Postoperative adjuvant therapy significantly increases survival and is indispensable in patients with pancreatic cancer after surgery [8]. In real clinical practice, there is considerable diversity in the methods of adjuvant therapy, since previous studies have reported the efficacy of various adjuvant chemotherapy and chemoradiation therapy regimens [8].…”

Section: Introductionmentioning

confidence: 99%

Lymph node ratio as valuable predictor in pancreatic cancer treated with R0 resection and adjuvant treatment

et al. 2019

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Background Lymph-node (LN) metastasis is an important prognostic factor in resected pancreatic cancer. In this study, the prognostic value of American Joint Committee on Cancer (AJCC) 8th edition N stage, lymph-node ratio (LNR), and log odds of positive lymph nodes (LODDS) in resected pancreatic cancer was investigated. Methods Between January 2005 and December 2017, there were 351 patients with pancreatic cancer treated with R0 resection and adjuvant therapy at Seoul National University Hospital. Relationships between the three LN parameters and overall survival (OS) and recurrence-free survival (RFS) were evaluated using a log-rank test and Cox proportional hazard regression model. Each multivariate-adjusted LN parameter was internally validated by bootstrap-corrected Harrell’s C-index. Results The mean duration from surgery to adjuvant therapy was 47.6 ± 17.4 days. In total, the median OS and RFS was 31.7 (95% CI, 27.2-37.2) and 15.4 (95% CI, 13.5-17.7) months. The three LN classification systems were significantly correlated with OS and RFS in log-rank tests and multivariate-adjusted models (all p < 0.05). When internally validated, LNR showed the highest discrimination ability in predicting OS and RFS (each C–index = 0.65). LNR also showed the highest C-index in subgroup analysis, classified by adjuvant therapy modality. LNR and the AJCC 8th edition LN classification system were significantly associated with loco-regional recurrence (p = 0.026 and p = 0.027, respectively). Conclusions LNR, which showed the best prognostic performance and significant relationship with loco-regional recurrence, can help further stratify the patients and establish an active treatment plan.

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“…Pancreatic cancer, the most common subtype of which is pancreatic ductal adenocarcinoma (PDAC), is the leading cause of cancer-related death in the United States and Korea [ 1 - 3 ]. In 2017, an estimated 448,000 people were diagnosed with PDAC and 441,000 people died from the disease worldwide.…”

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confidence: 99%

Lymph node size and its association with nodal metastasis in ductal adenocarcinoma of the pancreas

Shin

Lee

et al. 2020

J Pathol Transl Med

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Background: Although lymph node metastasis is a poor prognostic factor in patients with pancreatic ductal adenocarcinoma (PDAC), our understanding of lymph node size in association with PDAC is limited. Increased nodal size in preoperative imaging has been used to detect node metastasis. We evaluated whether lymph node size can be used as a surrogate preoperative marker of lymph node metastasis. Methods: We assessed nodal size and compared it to the nodal metastatic status of 200 patients with surgically resected PDAC. The size of all lymph nodes and metastatic nodal foci were measured along the long and short axis, and the relationships between nodal size and metastatic status were compared at six cutoff points. Results: A total of 4,525 lymph nodes were examined, 9.1% of which were metastatic. The mean size of the metastatic nodes (long axis, 6.9 ± 5.0 mm; short axis, 4.3 ± 3.1 mm) was significantly larger than that of the non-metastatic nodes (long axis, 5.0 ± 4.0 mm; short axis, 3.0 ± 2.0 mm; all p < .001). Using a 10 mm cutoff, the sensitivity, specificity, positive predictive value, overall accuracy, and area under curve was 24.8%, 88.0%, 17.1%, 82.3%, and 0.60 for the long axis and 7.0%, 99.0%, 40.3%, 90.6%, and 0.61 for the short axis, respectively. Conclusions: The metastatic nodes are larger than the non-metastatic nodes in PDAC patients. However, the difference in nodal size was too small to be identified with preoperative imaging. The performance of preoperative radiologic imaging to predict lymph nodal metastasis was not good. Therefore, nodal size cannot be used a surrogate preoperative marker of lymph node metastasis.

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Current Concepts in the Treatment of Resectable Pancreatic Cancer

Cited by 21 publications

References 29 publications

Prognostic factors following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Prognostic factors following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Lymph node ratio as valuable predictor in pancreatic cancer treated with R0 resection and adjuvant treatment

Lymph node size and its association with nodal metastasis in ductal adenocarcinoma of the pancreas

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