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Clinical Impact of Neoadjuvant Chemotherapy and Chemoradiotherapy in Borderline Resectable Pancreatic Cancer: Analysis of 884 Patients at Facilities Specializing in Pancreatic Surgery

  • Yuichi NagakawaEmail author
  • Yatsuka Sahara
  • Yuichi Hosokawa
  • Yoshiaki Murakami
  • Hiroki Yamaue
  • Sohei Satoi
  • Michiaki Unno
  • Shuji Isaji
  • Itaru Endo
  • Masayuki Sho
  • Tsutomu Fujii
  • Chie Takishita
  • Yosuke Hijikata
  • Shuji Suzuki
  • Shigeyuki Kawachi
  • Kenji Katsumata
  • Tetsuo Ohta
  • Takukazu Nagakawa
  • Akihiko Tsuchida
Pancreatic Tumors
  • 157 Downloads

Abstract

Background

The efficacy of neoadjuvant therapy (NAT), including neoadjuvant chemotherapy (NAC) and neoadjuvant chemo-radiotherapy (NACRT), for patients with borderline resectable pancreatic cancer (BRPC) has not been elucidated. This study aimed to clarify the efficacy of NAC and NACRT for patients with BRPC.

Methods

The study analyzed the treatment outcomes of 884 patients treated for BRPC from 2011 to 2013. Treatment results were compared between upfront surgery and NAT and between NAC and NACRT using propensity score-matching analysis. Overall survival (OS) was calculated via intention-to-treat analyses.

Results

The overall resection rates for the patients who underwent NAT were significantly lower than for the patients who underwent upfront surgery (75.1% vs 93.3%; p < 0.001). However, the R0 resection rate was significantly higher for NAT than for upfront surgery (p < 0.001). Additionally, the OS for the patients who received NAT was significantly longer than for those who underwent upfront surgery (median survival time [MST], 25.7 vs 19.0 months; p = 0.015). The lymph node rate for the patients with NACRT was significantly lower than for those who underwent NAC (p < 0.001). However, the resection rate for the NACRT cases was significantly lower than for the NAC cases (p = 0.041). The local recurrence rate for the NACRT cases was significantly lower than for the NAC cases (p = 0.002). However, OS did not differ significantly between NAC and NACRT (MST, 29.2 vs 22.5 months; p = 0.130).

Conclusions

The study showed that NAT has potential benefit for patients with BRPC. Compared with NAC, NACRT decreased the rates for lymph node metastasis and local recurrence but did not improve the prognosis.

Notes

Acknowledgment

We are especially grateful to the 63 leading Japanese institutions that kindly participated in the survey. The study was registered in the UMIN Clinical Trials Registry (UMIN-CTR: UMIN000021799).

Funding

This study was supported by the Japanese Society of Pancreatic Surgery and Tokyo Medical University

Disclosures

There are no conflicts of interest.

Ethical standards

This study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. This study was also approved by the relevant institutional review boards.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Yuichi Nagakawa
    • 1
    Email author
  • Yatsuka Sahara
    • 1
  • Yuichi Hosokawa
    • 1
  • Yoshiaki Murakami
    • 2
  • Hiroki Yamaue
    • 3
  • Sohei Satoi
    • 4
  • Michiaki Unno
    • 5
  • Shuji Isaji
    • 6
  • Itaru Endo
    • 7
  • Masayuki Sho
    • 8
  • Tsutomu Fujii
    • 9
  • Chie Takishita
    • 1
  • Yosuke Hijikata
    • 1
  • Shuji Suzuki
    • 10
  • Shigeyuki Kawachi
    • 11
  • Kenji Katsumata
    • 1
  • Tetsuo Ohta
    • 12
  • Takukazu Nagakawa
    • 12
  • Akihiko Tsuchida
    • 1
  1. 1.Department of Gastrointestinal and Pediatric SurgeryTokyo Medical UniversityShinjukuJapan
  2. 2.Department of Surgery, Institute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
  3. 3.Department of Gastroenterological SurgeryWakayama Medical UniversityWakayamaJapan
  4. 4.Department of SurgeryKansai Medical UniversityMoriguchiJapan
  5. 5.Department of Hepatobiliary-Pancreatic SurgeryTohoku University Graduate School of MedicineSendaiJapan
  6. 6.Department of Hepatobiliary Pancreatic and Transplant SurgeryMie University Graduate School of MedicineTsuJapan
  7. 7.Department of Gastroenterological SurgeryYokohama City University Graduate School of MedicineYokohamaJapan
  8. 8.Department of SurgeryNara Medical UniversityKashiharaJapan
  9. 9.Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical SciencesUniversity of ToyamaToyamaJapan
  10. 10.Department of Gastroenterological SurgeryTokyo Medical University Ibaraki Medical CenterInashikiJapan
  11. 11.Digestive and Transplantation SurgeryTokyo Medical University Hachioji Medical CenterHachiojiJapan
  12. 12.Department of Gastroenterological SurgeryKanazawa University Graduate School of Medical ScienceKanazawaJapan

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