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Circulating Tumor DNA as a Potential Prognostic Marker in Patients with Borderline-Resectable Pancreatic Cancer Undergoing Neoadjuvant Chemotherapy Followed by Pancreatectomy

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Circulating tumor DNA (ctDNA) might be a promising biomarker for pancreatic cancer in liquid biopsy. This study aimed to evaluate the usefulness of liquid biopsy for patients with borderline-resectable pancreatic cancer (BR-PC).

Methods

Patients with BR-PC according to the National Comprehensive Cancer Network guidelines (2017) and eligible for neoadjuvant chemotherapy (NAC) followed by pancreatectomy were recruited at Wakayama Medical University Hospital (UMIN000026647) between March 2017 and April 2020. The study enrolled 55 patients with locally advanced PC, and each patient consented to inclusion in the study. The study investigated the relationship between KRAS status in ctDNA and clinicopathologic features, analyzing ctDNA at three time points: pretreatment, post-NAC, and post-operation.

Results

Of the 55 enrolled patients with a diagnosis of BR-PC, 34 were scheduled to undergo pancreatectomy. From 27 patients with resected BR-PC, 81 blood samples were analyzed in triplicate for ctDNA. The patients with positive pretreatment and post-NAC ctDNA status had no significant decrease in median relapse-free survival (RFS) or overall survival (OS). However, the patients with positive postoperation ctDNA status had a significantly shorter median OS (723 days) than the patients with negative ctDNA results (not reached; P = 0.0148). A combined analysis of postoperative ctDNA and CA19-9 values showed the cumulative effect on both RFS (P = 0.0066) and OS (P = 0.0046). The adjusted hazard ratio for risk of survival computed for the patients carrying risk factors (either detectable ctDNA or CA19-9 > 37 U/ml) increased from 4.13-fold to 17.71-fold (both P = 0.0055) compared with the patients who had no risk factors.

Conclusion

Positive ctDNA predicts poor survival for patients with BR-PC who undergo NAC followed by pancreatectomy.

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Acknowledgments

We acknowledge the proofreading and editing by Benjamin Phillis at the Clinical Study Support Center, Wakayama Medical University.

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Authors and Affiliations

  1. Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan

    Yuji Kitahata MD, PhD, Manabu Kawai MD, PhD, Seiko Hirono MD, PhD, Ken-ichi Okada MD, PhD, Motoki Miyazawa MD, PhD, Hideki Motobayashi MD, Masaki Ueno MD, PhD, Shinya Hayami MD, PhD, Atsushi Miyamoto MD & Hiroki Yamaue MD, PhD

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  1. Yuji Kitahata MD, PhD
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  2. Manabu Kawai MD, PhD
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  3. Seiko Hirono MD, PhD
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  4. Ken-ichi Okada MD, PhD
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  5. Motoki Miyazawa MD, PhD
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  6. Hideki Motobayashi MD
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  7. Masaki Ueno MD, PhD
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Correspondence to Hiroki Yamaue MD, PhD.

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Kitahata, Y., Kawai, M., Hirono, S. et al. Circulating Tumor DNA as a Potential Prognostic Marker in Patients with Borderline-Resectable Pancreatic Cancer Undergoing Neoadjuvant Chemotherapy Followed by Pancreatectomy. Ann Surg Oncol 29, 1596–1605 (2022). https://doi.org/10.1245/s10434-021-10985-0

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