Prognostic factors of survival after neoadjuvant treatment and resection for initially unresectable pancreatic cancer / Ulla Klaiber, Eva S. Schnaidt, Ulf Hinz, Matthias M. Gaida, Ulrike Heger, Thomas Hank, Oliver Strobel, John P. Neoptolemos, André L. Mihaljevic, Markus W. Büchler, and Thilo Hackert

Mini - We analyzed prognostic factors after neoadjuvant therapy and resection in 280 patients with initially unresectable pancreatic cancer—the largest single-center study reported. We found that preoperative CA 19-9 levels, lymph node status, presence of distant metastases, and vascular involvement were all independent overall survival predictors, but not resection margin status. - Objective: - To evaluate the impact of clinical and pathological parameters, including resection margin (R) status, on survival in patients undergoing pancreatic surgery after neoadjuvant treatment for initially unresectable pancreatic ductal adenocarcinoma (PDAC). - Background: - Prognostic factors are well documented for patients with resectable PDAC, but have not been described in detail for patients with initially unresectable PDAC undergoing resection after neoadjuvant therapy. - Methods: - Prospectively collected data of consecutive patients with initially unresectable pancreatic cancer treated by neoadjuvant treatment and resection were analyzed. The R status was categorized as R0 (tumor-free margin >1 mm), R1 ≤1 mm (tumor-free margin ≤1 mm), and R1 direct (microscopic tumor infiltration at margin). Clinicopathological characteristics and outcomes were compared among these groups and tested for survival prediction. - Results: - Between January, 2006 and February, 2017, 280 patients with borderline resectable (n = 18), locally advanced (n = 190), or oligometastatic (n = 72) disease underwent tumor resection after neoadjuvant treatment. Median overall survival from the time of surgery was 25.1 months for R0 (n = 82), 15.3 months for R1 ≤1 mm (n = 99), and 16.1 months for R1 direct (n = 99), with 3-year overall survival rates of 35.0%, 20.7%, and 18.5%, respectively (P = 0.0076). The median duration of the neoadjuvant treatment period was 5.1 months. In multivariable analysis, preoperative CA 19-9 levels, lymph node status, metastasis category, and vascular involvement were all significant prognostic factors for overall survival. The R status was not an independent prognostic factor. - Conclusions: - In patients undergoing resection after neoadjuvant therapy for initially unresectable PDAC, preoperative CA 19-9 levels, lymph node involvement, metastasis category, and vascular involvement, but not the R status, were independent prognostic factors of overall survival..

Medienart:	E-Artikel

Erscheinungsjahr:	March 20, 2019 2021
Erschienen:	March 20, 2019

Enthalten in:	Zur Gesamtaufnahme - volume:273
Enthalten in:	Annals of surgery - 273(2021), 1 vom: Jan., Seite 154-162

Sprache:	Englisch

Beteiligte Personen:	Klaiber, Ulla, 1985- [VerfasserIn] Schnaidt, Eva S. [VerfasserIn] Hinz, Ulf [VerfasserIn] Gaida, Matthias, 1982- [VerfasserIn] Heger, Ulrike, 1979- [VerfasserIn] Hank, Thomas, 1985- [VerfasserIn] Strobel, Oliver, 1974- [VerfasserIn] Neoptolemos, John P. [VerfasserIn] Mihaljevic, André Leopold, 1977- [VerfasserIn] Büchler, Markus W., 1955- [VerfasserIn] Hackert, Thilo, 1971- [VerfasserIn]

Links:	Volltext [lizenzpflichtig] Volltext [lizenzpflichtig]

Anmerkungen:	Gesehen am 25.03.2021

Umfang:	9

doi:	10.1097/SLA.0000000000003270

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	1725506335