Neoadjuvant therapy for pancreatic cancer: an intention-to-treat analysis
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ORIGINAL ARTICLE
Neoadjuvant therapy for pancreatic cancer: an intention-to-treat analysis Kenjiro Okada 1 & Yoshiaki Murakami 1 & Kenichiro Uemura 1 & Naru Kondo 1 & Naoya Nakagawa 1 & Shingo Seo 1 & Hiroyuki Otsuka 1 & Shinya Takahashi 1 Received: 14 April 2020 / Accepted: 22 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose This study aimed to reassess the duration of neoadjuvant therapy (NAT) for patients with borderline resectable pancreatic cancer (BRPC). Methods The medical records of patients with BRPC who received NAT before intended curative resection were retrospectively reviewed. Patient demographics, clinicopathological factors, and prognostic factors for overall survival were analyzed. The serum carbohydrate antigen (CA) 19-9 level was examined monthly during NAT. Results A total of 118 patients with BRPC were enrolled. The median survival time and 5-year overall survival were 28.0 months and 31%, respectively. Three months after NAT, the CA19-9 levels were normal in 57% of the patients, and 92% underwent resection. Multivariate analysis showed that radiological partial response (hazard ratio (HR), 0.53; 95% confidence interval (CI), 0.26–0.99; p = 0.047); a normal CA19-9 level after NAT (HR, 0.30; 95% CI, 0.22–0.66; p = 0.006); and tumor resection (HR, 0.29; 95% CI, 0.13–0.67; p = 0.005) were independent predictors of better survival. The median CA19-9 level and the rate of normal CA19-9 levels before and after NAT were 256 (interquartile range (IQR), 23–1197) U/mL and 33%, and 27 (IQR, 7–176) U/mL and 57%, respectively. Conclusion A normal CA19-9 level after NAT was an independent predictor of better survival in patients with BRPC. A longer NAT duration might contribute to improved prognosis of patients with elevated CA19-9 levels. Keywords Borderline resectable pancreatic cancer . Neoadjuvant therapy . Tumor resection . Carbohydrate antigen 19-9
Abbreviations BRPC NAT CA19-9 MDCT ITT PV/SMV SMA CHA CA GS
Borderline resectable pancreatic cancer Neoadjuvant therapy Carbohydrate antigen 19-9 Multidetector-row computed tomography Intention-to-treat Portal or superior mesenteric vein Superior mesenteric artery Common hepatic artery Celiac axis Gemcitabine/S-1
* Kenjiro Okada [email protected] 1
Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551, Japan
GAS FOLFIRINOX RECIST OS HR CI RPC IQR MST UICC
Gemcitabine/nab-paclitaxel/S-1 Fluorouracil/leucovorin/ oxaliplatin/irinotecan Response evaluation criteria in solid tumors Overall survival Hazard ratio Confidence interval Resectable pancreatic cancer Interquartile range Median survival time International Union Against Cancer
Introduction The incidence of pancreatic cancer, a highly lethal malignancy, is increasing [1, 2]. Surgical resection provides the only chance of cure; however, only 15–20% of patients have resectable disease at the time of diagnosis. Nearly half have
Langenbecks Arch Surg
metastatic diseas
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