Textbook outcomes among patients undergoing curative resection of pancreatic ductal adenocarcinoma in the era of neoadjuvant therapy

Zhu, Lingyu; Fu, Zhendong; Liu, Xinyu; Li, Bo; Shi, Xiaohan; Gao, Suizhi; Yin, Xiaoyi; Wang, Huan; Shi, Meilong; Li, Penghao; Li, Yikai; Han, Jiawei; Ren, Yiwei; Wang, Jian; Zheng, Kailian; Guo, Shiwei; Jin, Gang

doi:10.1016/j.cson.2023.100012

Cited by 3 publications

(4 citation statements)

References 27 publications

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“…Genetic sequencing analyses or dynamic monitoring based in liquid biopsies in these populations may in turn guide the selection of chemotherapy regimens or switch. The TO rate after ypM0 resection was close to 90%, which was even higher than a cohort of patients who underwent upfront surgery for PDAC we reported before, [29] suggesting that conversion surgery was relatively safe in high-volume centers.…”

Section: Discussionmentioning

confidence: 58%

Survival outcomes of conversion surgery for metastatic pancreatic ductal adenocarcinoma after neoadjuvant therapy

Zhu

Gao

et al. 2023

Journal of Pancreatology

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Objective: To evaluate the survival outcomes of patients who underwent conversion surgery for metastatic pancreatic ductal adenocarcinoma (mPDAC) after neoadjuvant therapy (NAT) and to identify potential candidates that may benefit from this treatment strategy. Background: The role and eligibility population of conversion surgery for mPDAC remains controversial in the era of NAT. Methods: A consecutive cohort of patients diagnosed with mPDAC and treated with NAT followed by conversion surgery between 2019 and 2021 were confirmed from a prospective database maintained by the Department of Pancreatic Hepatobiliary Surgery of Changhai Hospital. In accordance with residual metastases and technical resectability after NAT, patients were classified as the complete pathological response of metastases (ypM0) resection group, residual metastases (ypM1) resection group, and exploration group. Median overall survival (mOS) was calculated using the Kaplan-Meier method, uni- and multivariable cox regression was performed to identify clinicopathological predictors of OS. Results: A total of 244 patients with mPDAC were identified from the prospective database, with 19 (7.8%) patients who underwent ypM0 resection, 22 (9.0%) underwent ypM1 resection, and 23 (9.4%) underwent explorative laparotomy. The mOS was 32.6 months for ypM0 resected patients, 15.1 months for ypM1 resected patients, and 13.4 months for those who underwent explorative laparotomy (P < .001). Univariable and multivariable Cox regression analyses confirmed that ypM0 resection, normalization of preoperative CA19-9 levels, and continued adjuvant therapy were independent prognostic factors of conversion surgery for mPDAC after NAT. Subgroup analyses revealed that oligometastases and continued adjuvant therapy were associated with improved prognosis in the ypM1 resection group. Conclusion: In patients with mPDAC who underwent NAT followed by conversion surgery, the complete pathological response of metastases, normalization of preoperative CA19-9 levels, and continued adjuvant therapy were independent risk factors for prognosis. Patients with residual oligometastases after treatment were expected to prolong survival through resection. These patients may benefit from conversion surgery and should be potential candidates for this treatment strategy.

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Section: Discussionmentioning

confidence: 58%

Survival outcomes of conversion surgery for metastatic pancreatic ductal adenocarcinoma after neoadjuvant therapy

Zhu

Gao

et al. 2023

Journal of Pancreatology

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“…In general, the vast majority of resectable tumors underwent UFS, with NAT recommended as a priority for patients with a combination of high-risk factors including high carbohydrate antigen 19 − 9 (CA19-9) levels, large tumors, regional lymph nodes suspected metastases, significant weight loss, and pain. All BR/LA tumors were treated with NAT followed by resection, with some patients with specific genetic mutations having access to clinical trials[ 15 ]. Gemcitabine plus albumin-bound(nab) paclitaxel (AG) has been recommended as the standard first-line neoadjuvant treatment because we were conducting several relevant clinical trials with AG as the main focus.…”

Section: Methodsmentioning

confidence: 99%

A neoadjuvant therapy compatible prognostic staging for resected pancreatic ductal adenocarcinoma

Zhu,

Shen,

Wang

et al. 2023

BMC Cancer

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Objective To improve prediction, the AJCC staging system was revised to be consistent with upfront surgery (UFS) and neoadjuvant therapy (NAT) for PDAC. Background The AJCC staging system was designed for patients who have had UFS for PDAC, and it has limited predictive power for patients receiving NAT. Methods We examined 146 PDAC patients who had resection after NAT and 1771 who had UFS at Changhai Hospital between 2012 and 2021. The clinicopathological factors were identified using Cox proportional regression analysis, and the Neoadjuvant Therapy Compatible Prognostic (NATCP) staging was developed based on these variables. Validation was carried out in the prospective NAT cohort and the SEER database. The staging approach was compared to the AJCC staging system regarding predictive accuracy. Results The NAT cohort’s multivariate analysis showed that tumor differentiation and the number of positive lymph nodes independently predicted OS. The NATCP staging simplified the AJCC stages, added tumor differentiation, and restaged the disease based on the Kaplan-Meier curve survival differences. The median OS for NATCP stages IA, IB, II, and III was 31.7 months, 25.0 months, and 15.8 months in the NAT cohort and 30.1 months, 22.8 months, 18.3 months, and 14.1 months in the UFS cohort. Compared to the AJCC staging method, the NATCP staging system performed better and was verified in the validation cohort. Conclusions Regardless of the use of NAT, NATCP staging demonstrated greater predictive abilities than the existing AJCC staging approach for resected PDAC and may facilitate clinical decision-making based on accurate prediction of patients’ OS.

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“…A prospective study conducted by Zhu et al revealed that there was no difference in achieving TO between the neoadjuvant chemotherapy group and the direct surgery group. This provided evidence at the perioperative management level to support the safety of neoadjuvant chemotherapy for PDAC patients ( 25 ). Numerous studies have conducted exploratory research on the application of the new concept of TO in pancreatic surgery, with different emphases.…”

Section: Introductionmentioning

confidence: 96%

“…Subsequently, more meticulously designed studies have emerged in the field of pancreatic surgery, particularly in the context of PD ( 22 - 25 ). Nicholas et al applied the new standard of TO in pancreatic surgery for the first time.…”

Section: Introductionmentioning

confidence: 99%

Association of textbook outcomes with improved survival in pancreatic ductal adenocarcinoma following pancreaticoduodenectomy: a retrospective study

Wang,

Hu,

Yin

et al. 2024

Transl Gastroenterol Hepatol

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Background Assessing the perioperative outcomes of pancreaticoduodenectomy (PD) based solely on individual complications is not comprehensive, and the association between perioperative outcomes and the long-term prognosis of individuals diagnosed with pancreatic ductal adenocarcinoma (PDAC) remains uncertain. Our study is designed to evaluate the impact of a novel composite indicator, textbook outcomes (TO), on the long-term prognosis of patients undergoing PD for PDAC. Methods This study conducted a retrospective analysis of 139 patients who underwent PD for pathologically confirmed PDAC at our hospital between January 2018 and December 2021. After applying exclusion criteria, a total of 111 patients were included in the subsequent analysis. These patients were categorized into two groups: the non-TO group (n=42) and the TO group (n=69). The Kaplan-Meier survival curve was employed to describe the relationship between TO and disease-free survival (DFS) and overall survival (OS). Cox regression was employed to assess the impact of achieving TO on long-term survival. Logistic regression was employed to investigate the risk factors affecting the achievement of TO. Results Out of the 111 PDAC patients, 69 (62.2%) achieved TO following PD. The achievement of TO significantly improved the OS of PDAC patients [P=0.03; hazard ratio (HR) =0.60; 95% confidence interval (CI): 0.37–0.83]. Cox regression analysis indicated that achieving TO was a protective factor for OS (P=0.04; HR =4.08; 95% CI: 1.07–15.61). Logistic regression analysis indicated that high amylase in drainage fluid on the third day after surgery (>1,300 U/L) was detrimental to achieve TO [odds ratio (OR) =0.10; 95% CI: 0.02–0.58; P=0.01], longer surgery durations (≥6.25 hours) was detrimental to achieve TO (OR =0.19; 95% CI: 0.06–0.54; P=0.002), and soft pancreatic texture was detrimental to achieve TO (OR =0.31; 95% CI: 0.10–0.93, P=0.04). Conclusions Achievement of TO significantly improves the OS of PDAC patients and has the potential to serve as a robust prognostic indicator. Looking ahead, it is highly necessary for TO to become a standard surgical quality control measure in hospitals.

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Textbook outcomes among patients undergoing curative resection of pancreatic ductal adenocarcinoma in the era of neoadjuvant therapy

Cited by 3 publications

References 27 publications

Survival outcomes of conversion surgery for metastatic pancreatic ductal adenocarcinoma after neoadjuvant therapy

Survival outcomes of conversion surgery for metastatic pancreatic ductal adenocarcinoma after neoadjuvant therapy

A neoadjuvant therapy compatible prognostic staging for resected pancreatic ductal adenocarcinoma

Association of textbook outcomes with improved survival in pancreatic ductal adenocarcinoma following pancreaticoduodenectomy: a retrospective study

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