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Neoadjuvant therapy contributes to nodal downstaging of pancreatic cancer

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Abstract

Purpose

This study aimed to assess the impact of neoadjuvant therapy (NAT) for borderline resectable or locally advanced pancreatic cancer (BR/LAPC) on the American Joint Commission on Cancer (AJCC) nodal status.

Methods

The medical records of BR/LAPC patients who underwent surgery with curative intent were retrospectively reviewed. The nodal status was compared between patients who underwent upfront surgery (UFS) and those who received NAT. Moreover, clinicopathological factors and prognostic factors for overall survival were analyzed.

Results

In all, 200 patients with BR/LAPC, 78 with UFS, and 122 with NAT were enrolled. The nodal status was significantly lower in patients after NAT than after UFS (p = 0.011). A multivariate analysis of overall survival showed that UFS (hazard ratio (HR) 1.61, p = 0.024) and N2 status (HR 2.69, p < 0.001) were independent poor prognostic factors. The median serum carbohydrate antigen (CA) 19–9 level after NAT in N2 patients was 105 U/mL, which was significantly higher than that of patients with N0 (p = 0.004) and N1 (p = 0.008) status.

Conclusion

Patients with BR/LAPC who underwent surgery after NAT had significantly lower N2 status and better prognosis than patients who underwent UFS. Elevated CA19-9 levels after NAT indicated a higher nodal status.

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Abbreviations

CA 19-9:

Carbohydrate antigen 19–9

AJCC:

American Joint Commission on Cancer

NAT:

Neoadjuvant therapy

UFS:

Upfront surgery

BR/LAPC:

Borderline resectable or locally advanced pancreatic cancer

FOLFIRINOX:

Fluorouracil/leucovorin/oxaliplatin/irinotecan

MDCT:

Multi-detector row computed tomography

GS:

Gemcitabine/S-1

GAS:

Gemcitabine/nab-paclitaxel/S-1

PV/SMV:

Portal or superior mesenteric vein

OS:

Overall survival

HR:

Hazard ratio

CI:

Confidence interval

IQR:

Interquartile range

LNR:

Lymph node ratio

MST:

Median survival time

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Author information

Authors and Affiliations

  1. Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8551, Japan

    Kenjiro Okada, Kenichiro Uemura, Naru Kondo, Tatsuaki Sumiyoshi, Shingo Seo, Hiroyuki Otsuka, Yoshiaki Murakami & Shinya Takahashi

  2. Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Masahiro Serikawa, Yasutaka Ishii & Tomofumi Tsuboi

Authors
  1. Kenjiro Okada
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  2. Kenichiro Uemura
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  3. Naru Kondo
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  4. Tatsuaki Sumiyoshi
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  5. Shingo Seo
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  6. Hiroyuki Otsuka
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  7. Masahiro Serikawa
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  8. Yasutaka Ishii
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  11. Shinya Takahashi
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Contributions

Study conception and design: Kenjiro Okada, Kenichiro Uemura, Naru Kondo, Yoshiaki Murakami, Shinya Takahashi. Acquisition of data: Kenjiro Okada, Tatsuaki Sumiyoshi, Shingo Seo, Hiroyuki Otsuka, Masahiro Serikawa, Yasutaka Ishii, Tomofumi Tsuboi. Analysis and interpretation of data: Kenjiro Okada, Kenichiro Uemura, Naru Kondo, Tatsuaki Sumiyoshi, Shingo Seo, Hiroyuki Otsuka, Masahiro Serikawa, Yasutaka Ishii, Tomofumi Tsuboi. Drafting of manuscript: Kenjiro Okada, Kenichiro Uemura, Naru Kondo. Critical revision of manuscript: Kenjiro Okada, Kenichiro Uemura, Naru Kondo, Yoshiaki Murakami, Shinya Takahashi.

Corresponding author

Correspondence to Kenichiro Uemura.

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Okada, K., Uemura, K., Kondo, N. et al. Neoadjuvant therapy contributes to nodal downstaging of pancreatic cancer. Langenbecks Arch Surg 407, 623–632 (2022). https://doi.org/10.1007/s00423-021-02339-x

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