Prognostic factors of survival after neoadjuvant treatment and resection for initially unresectable pancreatic cancer

• Verfasst von: Klaiber, Ulla [VerfasserIn]
• Verfasst von: Schnaidt, Eva Simone [VerfasserIn]
• Verfasst von: Hinz, Ulf [VerfasserIn]
• Verfasst von: Gaida, Matthias [VerfasserIn]
• Verfasst von: Heger, Ulrike [VerfasserIn]
• Verfasst von: Hank, Thomas [VerfasserIn]
• Verfasst von: Strobel, Oliver [VerfasserIn]
• Verfasst von: Neoptolemos, John P. [VerfasserIn]
• Verfasst von: Mihaljevic, André Leopold [VerfasserIn]
• Verfasst von: Büchler, Markus W. [VerfasserIn]
• Verfasst von: Hackert, Thilo [VerfasserIn]
• Titel: Prognostic factors of survival after neoadjuvant treatment and resection for initially unresectable pancreatic cancer
• Verf.angabe: Ulla Klaiber, Eva S. Schnaidt, Ulf Hinz, Matthias M. Gaida, Ulrike Heger, Thomas Hank, Oliver Strobel, John P. Neoptolemos, André L. Mihaljevic, Markus W. Büchler, and Thilo Hackert
• E-Jahr: 2019
• Jahr: March 20, 2019
• Umfang: 9 S.
• Fussnoten: Gesehen am 25.03.2021
• Titel Quelle: Enthalten in: Annals of surgery
• Ort Quelle: [Erscheinungsort nicht ermittelbar] : Lippincott Williams & Wilkins, 1885
• Jahr Quelle: 2021
• Band/Heft Quelle: 273(2021), 1 vom: Jan., Seite 154-162
• ISSN Quelle: 1528-1140
• DOI: doi:10.1097/SLA.0000000000003270
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1725506335

Abstract

Mini - We analyzed prognostic factors after neoadjuvant therapy and resection in 280 patients with initially unresectable pancreatic cancer—the largest single-center study reported. We found that preoperative CA 19-9 levels, lymph node status, presence of distant metastases, and vascular involvement were all independent overall survival predictors, but not resection margin status. - Objective: - To evaluate the impact of clinical and pathological parameters, including resection margin (R) status, on survival in patients undergoing pancreatic surgery after neoadjuvant treatment for initially unresectable pancreatic ductal adenocarcinoma (PDAC). - Background: - Prognostic factors are well documented for patients with resectable PDAC, but have not been described in detail for patients with initially unresectable PDAC undergoing resection after neoadjuvant therapy. - Methods: - Prospectively collected data of consecutive patients with initially unresectable pancreatic cancer treated by neoadjuvant treatment and resection were analyzed. The R status was categorized as R0 (tumor-free margin >1 mm), R1 ≤1 mm (tumor-free margin ≤1 mm), and R1 direct (microscopic tumor infiltration at margin). Clinicopathological characteristics and outcomes were compared among these groups and tested for survival prediction. - Results: - Between January, 2006 and February, 2017, 280 patients with borderline resectable (n = 18), locally advanced (n = 190), or oligometastatic (n = 72) disease underwent tumor resection after neoadjuvant treatment. Median overall survival from the time of surgery was 25.1 months for R0 (n = 82), 15.3 months for R1 ≤1 mm (n = 99), and 16.1 months for R1 direct (n = 99), with 3-year overall survival rates of 35.0%, 20.7%, and 18.5%, respectively (P = 0.0076). The median duration of the neoadjuvant treatment period was 5.1 months. In multivariable analysis, preoperative CA 19-9 levels, lymph node status, metastasis category, and vascular involvement were all significant prognostic factors for overall survival. The R status was not an independent prognostic factor. - Conclusions: - In patients undergoing resection after neoadjuvant therapy for initially unresectable PDAC, preoperative CA 19-9 levels, lymph node involvement, metastasis category, and vascular involvement, but not the R status, were independent prognostic factors of overall survival.