Survival outcome and prognostic factors of neoadjuvant treatment followed by resection for borderline resectable pancreatic cancer

Abstract

PurposeNeoadjuvant treatment may provide improved survival outcomes for patients with borderline resectable pancreatic cancer (BRPC). The purpose of this study is to evaluate the clinical outcomes of neoadjuvant treatment and to identify prognostic factors.MethodsForty patients who met the National Comprehensive Cancer Network definition of BRPC and received neoadjuvant treatment followed by surgery between 2007 and 2015 were evaluated. Prospectively collected clinicopathological outcomes were analyzed retrospectively.ResultsThe mean age was 61.7 years and the male-to-female ratio was 1.8:1. Twenty-six, 3, and 11 patients received gemcitabine-based chemotherapy, 5-fluorouracil, and FOLFIRINOX, respectively. The 2-year survival rate (2YSR) was 36.6% and the median overall survival (OS) was 20 months. Of the 40 patients, 34 patients underwent resection and the 2YSR was 41.2% while the 2YSR of patients who did not undergo resection was 16.7% (P = 0.011). The 2YSR was significantly higher in patients who had partial response compared to stable disease (60.6% vs. 24.3%, P = 0.038), in patients who did than did not show a CA 19-9 response after neoadjuvant treatment (40.5% vs. 0%, P = 0.039) and in patients who did than did not receive radiotherapy (50.8% vs. 25.3%, P = 0.036). Five patients had local recurrence and 17 patients had systemic recurrence with a median disease specific survival of 15 months.ConclusionNeoadjuvant treatment followed by resection is effective for BRPC. Pancreatectomy and neoadjuvant treatment response may affect survival. Effective systemic therapy is needed to improve long-term survival since systemic metastasis accounts for a high proportion of recurrence.

Arterial resection during pancreatectomy for pancreatic ductal adenocarcinoma with arterial invasion

“…[ 17 , 25 ] In addition, patients with partial response showed better OS than patients with stable disease (33.7 vs 17.5 months, P = .04), and similar results have been previously reported. [ 26 ] On the basis of these results, pancreatectomy with AR could be particularly useful in patients with partial response after neoadjuvant chemotherapy. In the subgroup analysis according to operation type, the oncologic outcome was better in the neoadjuvant chemotherapy group after PD and TP, but not after DP.…”

Outcome of Patients with Borderline Resectable Pancreatic Cancer in the Contemporary Era of Neoadjuvant Chemotherapy

“…15,24 In a meta-analysis, the rate of R0 resection in BRPC patients after receipt of neoadjuvant therapy was 54%. 21 In another study on 15 BRPC patients who underwent resection, one (7%) underwent an R1 resection.…”

Long Lasting Response in Metastatic Pancreatic Exocrine Cancer: Abnormality or Diagnostic Miss? A Case Report with Brief Literature Review

“…The latter could serve as a good prognostic factor to be confirmed by analysis of bigger data sets. As previously reported, the levels of Ca 19-9 at the onset of the disease may represent an interesting prognostic factor [9]. Spinelli et al reported a case of a long term survivor with more than 10 years after diagnosis of PEC with metastatic disease, but unfortunately there is no mention of Ca 19-9 levels [10].…”