TY - JOUR
T1 - Significance of neoadjuvant therapy for borderline resectable pancreatic cancer
T2 - a multicenter retrospective study
AU - Kurahara, Hiroshi
AU - Shinchi, Hiroyuki
AU - Takao, Ohtsuka
AU - Miyasaka, Yoshihiro
AU - Matsunaga, Taketo
AU - Noshiro, Hirokazu
AU - Adachi, Tomohiko
AU - Eguchi, Susumu
AU - Imamura, Naoya
AU - Nanashima, Atsushi
AU - Sakamoto, Kazuhiko
AU - Nagano, Hiroaki
AU - Ohta, Masayuki
AU - Inomata, Masafumi
AU - Chikamoto, Akira
AU - Baba, Hideo
AU - Watanabe, Yusuke
AU - Nishihara, Kazuyoshi
AU - Yasunaga, Masafumi
AU - Okuda, Koji
AU - Natsugoe, Shoji
AU - Nakamura, Masafumi
N1 - Funding Information:
We thank Dr. Yuko Mataki and Dr. Kosei Maemura from Kagoshima University for acquiring the data.
Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2019/3/15
Y1 - 2019/3/15
N2 - Purpose: Neoadjuvant therapy (NAT) is increasingly used to improve the prognosis of patients with borderline resectable pancreatic cancer (BRPC) albeit with little evidence of its advantage over upfront surgical resection. We analyzed the prognostic impact of NAT on patients with BRPC in a multicenter retrospective study. Methods: Medical data of 165 consecutive patients who underwent treatment for BRPC between January 2010 and December 2014 were collected from ten institutions. We defined BRPC according to the National Comprehensive Cancer Network guidelines, and subclassified patients according to venous invasion alone (BR-PV) and arterial invasion (BR-A). Results: The rates of NAT administration and resection were 35% and 79%, respectively. There were no significant differences in resection rates and prognoses between patients in the BR-PV and BR-A subgroups. NAT did not have a significant impact on prognosis according to intention-to-treat analysis. However, in patients who underwent surgical resection, NAT was independently associated with longer overall survival (OS). The median OS of patients who underwent resection after NAT (53.7 months) was significantly longer than that of patients who underwent upfront (17.8 months) or no resection (14.9 months). The rates of superior mesenteric or portal vein invasion, lymphatic invasion, venous invasion, and lymph node metastasis were significantly lower in patients who underwent resection after NAT than in those who underwent upfront resection despite similar baseline clinical profiles. Conclusions: Resection after NAT in patients with BRPC is associated with longer OS and lower rates of both invasion to the surrounding tissues and lymph node metastasis.
AB - Purpose: Neoadjuvant therapy (NAT) is increasingly used to improve the prognosis of patients with borderline resectable pancreatic cancer (BRPC) albeit with little evidence of its advantage over upfront surgical resection. We analyzed the prognostic impact of NAT on patients with BRPC in a multicenter retrospective study. Methods: Medical data of 165 consecutive patients who underwent treatment for BRPC between January 2010 and December 2014 were collected from ten institutions. We defined BRPC according to the National Comprehensive Cancer Network guidelines, and subclassified patients according to venous invasion alone (BR-PV) and arterial invasion (BR-A). Results: The rates of NAT administration and resection were 35% and 79%, respectively. There were no significant differences in resection rates and prognoses between patients in the BR-PV and BR-A subgroups. NAT did not have a significant impact on prognosis according to intention-to-treat analysis. However, in patients who underwent surgical resection, NAT was independently associated with longer overall survival (OS). The median OS of patients who underwent resection after NAT (53.7 months) was significantly longer than that of patients who underwent upfront (17.8 months) or no resection (14.9 months). The rates of superior mesenteric or portal vein invasion, lymphatic invasion, venous invasion, and lymph node metastasis were significantly lower in patients who underwent resection after NAT than in those who underwent upfront resection despite similar baseline clinical profiles. Conclusions: Resection after NAT in patients with BRPC is associated with longer OS and lower rates of both invasion to the surrounding tissues and lymph node metastasis.
UR - http://www.scopus.com/inward/record.url?scp=85060160784&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85060160784&partnerID=8YFLogxK
U2 - 10.1007/s00423-019-01754-5
DO - 10.1007/s00423-019-01754-5
M3 - Article
C2 - 30649607
AN - SCOPUS:85060160784
SN - 1435-2443
VL - 404
SP - 167
EP - 174
JO - Langenbeck's Archives of Surgery
JF - Langenbeck's Archives of Surgery
IS - 2
ER -