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ATP assay-guided chemosensitivity testing for gemcitabine with biopsy specimens obtained from unresectable pancreatic cancer using endoscopic ultrasonography-guided fine-needle aspiration

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Abstract

Objectives

This study evaluates the feasibility of chemosensitivity testing by use of endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) samples and determines the optimum cut-off value for gemcitabine.

Methods

Thirty-four consecutive patients with unresectable pancreatic cancer were enrolled. Chemosensitivity (treated/control ratio: T/C ratio) was calculated as the quantity of adenosine triphosphate for a tumor treated with gemcitabine as a percentage of that for the control. To identify the cut-off value sufficient to predict 180 days of progression-free survival (PFS), the receiver operating characteristic curve and the corresponding area under the curve (AUC) were calculated.

Results

The success of this assay was 88.2% (30/34); therefore, 30 patients were assessable and included in the population of analyzable patients.. The response was 6.7%. Median PFS was 96 days and median overall survival was 241 days, respectively. The cut-off value was determined as 74% (AUC, 0.745; p = 0.053; 95% CI 0.485–1.005). According to this cut-off value, we predicted 180 days PFS with a sensitivity and specificity of 71.4 and 91.3%, respectively. When patients were divided into two groups at T/C ratio 74%, a significant difference was found in PFS (median 77 vs. 205 days, p = 0.0036). Moreover, T/C ratio < 74% and decrease of CA19-9 were significant and independent prognostic factors by multivariate analysis.

Conclusion

Chemosensitivity testing by use of EUS-FNA samples in patients with unresectable pancreatic cancer is feasible. This definition emphasizes the possibility of selecting patients for whom favorable results from gemcitabine treatment can be expected.

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Acknowledgments

We thank Aya Goto (Fukushima Medical University School of Medicine, Department of Public Health) for help in statistical analysis and Kyoko Onuma for technical assistance.

Conflict of interest

No author has any conflict of interest.

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Authors and Affiliations

  1. Department of Gastroenterology and Rheumatology, Fukushima Medical University, School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan

    Takeru Wakatsuki, Atsushi Irisawa, Goro Shibukawa, Tadayuki Takagi, Hidemichi Imamura, Yuta Takahashi, Ai Sato, Masaki Sato, Tsunehiko Ikeda, Rei Suzuki & Hiromasa Ohira

  2. Division of Gastric Surgery, Shizuoka Cancer Center, Sunto-gun, Shizuoka, 411-8777, Japan

    Masanori Terashima

  3. Department of Endoscopy, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, 960-1295, Japan

    Takuto Hikichi & Katsutoshi Obara

  4. Department of Gastroenterology, Fukushima Red Cross Hospital, 11-31 Iriecho, Fukushima, 960-8530, Japan

    Takeru Wakatsuki

Authors
  1. Takeru Wakatsuki
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  2. Atsushi Irisawa
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Correspondence to Takeru Wakatsuki.

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Wakatsuki, T., Irisawa, A., Terashima, M. et al. ATP assay-guided chemosensitivity testing for gemcitabine with biopsy specimens obtained from unresectable pancreatic cancer using endoscopic ultrasonography-guided fine-needle aspiration. Int J Clin Oncol 16, 387–394 (2011). https://doi.org/10.1007/s10147-011-0197-3

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  • DOI: https://doi.org/10.1007/s10147-011-0197-3

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