Significance of neoadjuvant therapy for borderline resectable pancreatic cancer: a multicenter retrospective study
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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.
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).
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.
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.
KeywordsChemotherapy Chemoradiotherapy Metastasis Resection
We thank Dr. Yuko Mataki and Dr. Kosei Maemura from Kagoshima University for acquiring the data.
Hiroshi Kurahara and Hiroyuki Shinchi: Study conception and design, drafting of manuscript. Oshihiro Miyasaka, Taketo Matsunaga, Tomohiko Adachi, Naoya Imamura, Kazuhiko Sakamoto, Masayuki Ohta, Akira Chikamoto, Yusuke Watanabe, and Masafumi Yasunaga: Acquisition of data. Takao Ohtsuka, Hirokazu Noshiro, Susumu Eguchi, Atsushi Nanashima, Hiroaki Nagano, Masafumi Inomata, Hideo Baba, Kazuyoshi Nishihara, and Koji Okuda: Analysis and interpretation of data. Shoji Natsugoe and Masafumi Nakamura: Critical revision of manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
Informed consent was obtained from all individual participants included in the study.
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