Factors predicting survival in patients with locally advanced pancreatic cancer undergoing pancreatectomy with arterial resection

Abstract

Pancreatectomy with arterial resection is a treatment option in selected patients with locally advanced pancreatic cancer. This study aimed to identify factors predicting cancer-specific survival in this patient population. A single-Institution prospective database was used. Pre-operative prognostic factors were identified and used to develop a prognostic score. Matching with pathologic parameters was used for internal validation. In a patient population with a median Ca 19.9 level of 19.8 U/mL(IQR: 7.1–77), cancer-specific survival was predicted by: metabolic deterioration of diabetes (OR = 0.22, p = 0.0012), platelet count (OR = 1.00; p = 0.0013), serum level of Ca 15.3 (OR = 1.01, p = 0.0018) and Ca 125 (OR = 1.02, p = 0.00000137), neutrophils-to-lymphocytes ratio (OR = 1.16; p = 0.00015), lymphocytes-to-monocytes ratio (OR = 0.88; p = 0.00233), platelets-to-lymphocytes ratio (OR = 0.99; p = 0.00118), and FOLFIRINOX neoadjuvant chemotherapy (OR = 0.57; p = 0.00144). A prognostic score was developed and three risk groups were identified. Harrell’s C-Index was 0.74. Median cancer-specific survival was 16.0 months (IQR: 12.3–28.2) for the high-risk group, 24.7 months (IQR: 17.6–33.4) for the intermediate-risk group, and 39.0 months (IQR: 22.7–NA) for the low-risk group (p = 0.0003). Matching the three risk groups against pathology parameters, N2 rate was 61.9, 42.1, and 23.8% (p = 0.04), median value of lymph-node ratio was 0.07 (IQR: 0.05–0.14), 0.04 (IQR:0.02–0.07), and 0.03 (IQR: 0.01–0.04) (p = 0.008), and mean value of logarithm odds of positive nodes was − 1.07 ± 0.5, − 1.3 ± 0.4, and − 1.4 ± 0.4 (p = 0.03), in the high-risk, intermediate-risk, and low-risk groups, respectively. An online calculator is available at www.survivalcalculator-lapdac-arterialresection.org. The prognostic factors identified in this study predict cancer-specific survival in patients with locally advanced pancreatic cancer and low Ca 19.9 levels undergoing pancreatectomy with arterial resection.

Pancreatectomy After Neoadjuvant FOLFIRINOX Chemotherapy: Identifying Factors Predicting Long‐Term Survival

“…In particular, the survival rates observed in patients undergoing arterial resection in the current study (median overall survival 24.7 months, 5‐year survival rate of 27%) are superior to that reported by exclusive medical treatment in one recent study from our country (median OS of 18.7 months, 5‐year survival rate 1%) [32]. Our study confirmed good operative and survival outcomes reported by other studies [4, 7–10, 14–17, 20, 21, 23].…”

“…Pancreatectomy with vascular resection has been gradually abandoned since its first description by Fortner et al [33] because of the high post‐operative mortality and the poor survival rates. Nowadays, the experience by pioneer centers in vascular resection [7, 11, 15–17, 20] for pancreatic adenocarcinomas combined with the major pathological and radiological results seen after neoadjuvant chemotherapy with FOFLRINOX could validate those pancreatic resections in the multimodal treatment of LA pancreatic adenocarcinoma.…”

“…Those pancreatic resections associated with venous and/ or arterial resection are still under evaluation for the treatment of pancreatic cancer because of the higher morbidity and mortality rates compared with standard pancreatic resection [12,13]. The feasibility of those operations has been well demonstrated in high volume centers performed by trained vascular-pancreatic surgeons, but optimal selection criteria for surgery must be still defined, and the role of surgery for locally advanced disease is still being debated [7,8,11,[14][15][16][17][18].Several studies have analyzed the outcomes of pancreatic resection after preoperative FOLFIRINOX neoadjuvant chemotherapy providing survival outcomes after resection and identifying several prognostic criteria [5,9,[19][20][21][22]. Still few studies provided amount of data concerning patients undergoing pancreatectomy with venous and arteria resection for locally advanced pancreatic adenocarcinomas [4,11,[21][22][23].…”

CA19.9 Serum Level Predicts Lymph-Nodes Status in Resectable Pancreatic Ductal Adenocarcinoma: A Retrospective Single-Center Analysis

“…Nonetheless, it has to be taken into account that the decrease of Ca 19.9 levels has been used to plan arterial vascular resection for locally advanced pancreatic cancer after NAT, as well as to predict progression of the disease after treatment in advanced cases (39,40).…”

Feasibility and safety of robotic-assisted total pancreatectomy: a pilot western series

“…Currently, total pancreatectomy is performed selectively, in approximately 6% of the patients who receive a pancreatic resection [7]. In the majority of these patients, total pancreatectomy is required due to widespread involvement of the gland [8] or in case of locally advanced tumors requiring arterial resection and reconstruction [9]. These indications may not apply well to a minimally invasive approach.…”