Significance of neoadjuvant therapy for borderline resectable pancreatic cancer: a multicenter retrospective study

Hiroshi Kurahara, Hiroyuki Shinchi, Ohtsuka Takao, Yoshihiro Miyasaka, Taketo Matsunaga, Hirokazu Noshiro, Tomohiko Adachi, Susumu Eguchi, Naoya Imamura, Atsushi Nanashima, Kazuhiko Sakamoto, Hiroaki Nagano, Masayuki Ohta, Masafumi Inomata, Akira Chikamoto, Hideo Baba, Yusuke Watanabe, Kazuyoshi Nishihara, Masafumi Yasunaga, Koji OkudaShoji Natsugoe, Masafumi Nakamura

Research output: Contribution to journalArticle

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Abstract

Purpose: Neoadjuvant therapy (NAT) is increasingly used to improve the prognosis of patients with borderline resectable pancreatic cancer (BRPC) albeit with little evidence of its advantage over upfront surgical resection. We analyzed the prognostic impact of NAT on patients with BRPC in a multicenter retrospective study. Methods: Medical data of 165 consecutive patients who underwent treatment for BRPC between January 2010 and December 2014 were collected from ten institutions. We defined BRPC according to the National Comprehensive Cancer Network guidelines, and subclassified patients according to venous invasion alone (BR-PV) and arterial invasion (BR-A). Results: The rates of NAT administration and resection were 35% and 79%, respectively. There were no significant differences in resection rates and prognoses between patients in the BR-PV and BR-A subgroups. NAT did not have a significant impact on prognosis according to intention-to-treat analysis. However, in patients who underwent surgical resection, NAT was independently associated with longer overall survival (OS). The median OS of patients who underwent resection after NAT (53.7 months) was significantly longer than that of patients who underwent upfront (17.8 months) or no resection (14.9 months). The rates of superior mesenteric or portal vein invasion, lymphatic invasion, venous invasion, and lymph node metastasis were significantly lower in patients who underwent resection after NAT than in those who underwent upfront resection despite similar baseline clinical profiles. Conclusions: Resection after NAT in patients with BRPC is associated with longer OS and lower rates of both invasion to the surrounding tissues and lymph node metastasis.

Original languageEnglish
Pages (from-to)167-174
Number of pages8
JournalLangenbeck's Archives of Surgery
Volume404
Issue number2
DOIs
Publication statusPublished - Mar 15 2019

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Neoadjuvant Therapy
Pancreatic Neoplasms
Multicenter Studies
Retrospective Studies
Lymph Nodes
Neoplasm Metastasis
Mesenteric Veins
Intention to Treat Analysis
Survival
Portal Vein
Survival Rate
Guidelines

All Science Journal Classification (ASJC) codes

  • Surgery

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Significance of neoadjuvant therapy for borderline resectable pancreatic cancer : a multicenter retrospective study. / Kurahara, Hiroshi; Shinchi, Hiroyuki; Takao, Ohtsuka; Miyasaka, Yoshihiro; Matsunaga, Taketo; Noshiro, Hirokazu; Adachi, Tomohiko; Eguchi, Susumu; Imamura, Naoya; Nanashima, Atsushi; Sakamoto, Kazuhiko; Nagano, Hiroaki; Ohta, Masayuki; Inomata, Masafumi; Chikamoto, Akira; Baba, Hideo; Watanabe, Yusuke; Nishihara, Kazuyoshi; Yasunaga, Masafumi; Okuda, Koji; Natsugoe, Shoji; Nakamura, Masafumi.

In: Langenbeck's Archives of Surgery, Vol. 404, No. 2, 15.03.2019, p. 167-174.

Research output: Contribution to journalArticle

Kurahara, H, Shinchi, H, Takao, O, Miyasaka, Y, Matsunaga, T, Noshiro, H, Adachi, T, Eguchi, S, Imamura, N, Nanashima, A, Sakamoto, K, Nagano, H, Ohta, M, Inomata, M, Chikamoto, A, Baba, H, Watanabe, Y, Nishihara, K, Yasunaga, M, Okuda, K, Natsugoe, S & Nakamura, M 2019, 'Significance of neoadjuvant therapy for borderline resectable pancreatic cancer: a multicenter retrospective study', Langenbeck's Archives of Surgery, vol. 404, no. 2, pp. 167-174. https://doi.org/10.1007/s00423-019-01754-5
Kurahara, Hiroshi ; Shinchi, Hiroyuki ; Takao, Ohtsuka ; Miyasaka, Yoshihiro ; Matsunaga, Taketo ; Noshiro, Hirokazu ; Adachi, Tomohiko ; Eguchi, Susumu ; Imamura, Naoya ; Nanashima, Atsushi ; Sakamoto, Kazuhiko ; Nagano, Hiroaki ; Ohta, Masayuki ; Inomata, Masafumi ; Chikamoto, Akira ; Baba, Hideo ; Watanabe, Yusuke ; Nishihara, Kazuyoshi ; Yasunaga, Masafumi ; Okuda, Koji ; Natsugoe, Shoji ; Nakamura, Masafumi. / Significance of neoadjuvant therapy for borderline resectable pancreatic cancer : a multicenter retrospective study. In: Langenbeck's Archives of Surgery. 2019 ; Vol. 404, No. 2. pp. 167-174.
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abstract = "Purpose: Neoadjuvant therapy (NAT) is increasingly used to improve the prognosis of patients with borderline resectable pancreatic cancer (BRPC) albeit with little evidence of its advantage over upfront surgical resection. We analyzed the prognostic impact of NAT on patients with BRPC in a multicenter retrospective study. Methods: Medical data of 165 consecutive patients who underwent treatment for BRPC between January 2010 and December 2014 were collected from ten institutions. We defined BRPC according to the National Comprehensive Cancer Network guidelines, and subclassified patients according to venous invasion alone (BR-PV) and arterial invasion (BR-A). Results: The rates of NAT administration and resection were 35{\%} and 79{\%}, respectively. There were no significant differences in resection rates and prognoses between patients in the BR-PV and BR-A subgroups. NAT did not have a significant impact on prognosis according to intention-to-treat analysis. However, in patients who underwent surgical resection, NAT was independently associated with longer overall survival (OS). The median OS of patients who underwent resection after NAT (53.7 months) was significantly longer than that of patients who underwent upfront (17.8 months) or no resection (14.9 months). The rates of superior mesenteric or portal vein invasion, lymphatic invasion, venous invasion, and lymph node metastasis were significantly lower in patients who underwent resection after NAT than in those who underwent upfront resection despite similar baseline clinical profiles. Conclusions: Resection after NAT in patients with BRPC is associated with longer OS and lower rates of both invasion to the surrounding tissues and lymph node metastasis.",
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T1 - Significance of neoadjuvant therapy for borderline resectable pancreatic cancer

T2 - a multicenter retrospective study

AU - Kurahara, Hiroshi

AU - Shinchi, Hiroyuki

AU - Takao, Ohtsuka

AU - Miyasaka, Yoshihiro

AU - Matsunaga, Taketo

AU - Noshiro, Hirokazu

AU - Adachi, Tomohiko

AU - Eguchi, Susumu

AU - Imamura, Naoya

AU - Nanashima, Atsushi

AU - Sakamoto, Kazuhiko

AU - Nagano, Hiroaki

AU - Ohta, Masayuki

AU - Inomata, Masafumi

AU - Chikamoto, Akira

AU - Baba, Hideo

AU - Watanabe, Yusuke

AU - Nishihara, Kazuyoshi

AU - Yasunaga, Masafumi

AU - Okuda, Koji

AU - Natsugoe, Shoji

AU - Nakamura, Masafumi

PY - 2019/3/15

Y1 - 2019/3/15

N2 - Purpose: Neoadjuvant therapy (NAT) is increasingly used to improve the prognosis of patients with borderline resectable pancreatic cancer (BRPC) albeit with little evidence of its advantage over upfront surgical resection. We analyzed the prognostic impact of NAT on patients with BRPC in a multicenter retrospective study. Methods: Medical data of 165 consecutive patients who underwent treatment for BRPC between January 2010 and December 2014 were collected from ten institutions. We defined BRPC according to the National Comprehensive Cancer Network guidelines, and subclassified patients according to venous invasion alone (BR-PV) and arterial invasion (BR-A). Results: The rates of NAT administration and resection were 35% and 79%, respectively. There were no significant differences in resection rates and prognoses between patients in the BR-PV and BR-A subgroups. NAT did not have a significant impact on prognosis according to intention-to-treat analysis. However, in patients who underwent surgical resection, NAT was independently associated with longer overall survival (OS). The median OS of patients who underwent resection after NAT (53.7 months) was significantly longer than that of patients who underwent upfront (17.8 months) or no resection (14.9 months). The rates of superior mesenteric or portal vein invasion, lymphatic invasion, venous invasion, and lymph node metastasis were significantly lower in patients who underwent resection after NAT than in those who underwent upfront resection despite similar baseline clinical profiles. Conclusions: Resection after NAT in patients with BRPC is associated with longer OS and lower rates of both invasion to the surrounding tissues and lymph node metastasis.

AB - Purpose: Neoadjuvant therapy (NAT) is increasingly used to improve the prognosis of patients with borderline resectable pancreatic cancer (BRPC) albeit with little evidence of its advantage over upfront surgical resection. We analyzed the prognostic impact of NAT on patients with BRPC in a multicenter retrospective study. Methods: Medical data of 165 consecutive patients who underwent treatment for BRPC between January 2010 and December 2014 were collected from ten institutions. We defined BRPC according to the National Comprehensive Cancer Network guidelines, and subclassified patients according to venous invasion alone (BR-PV) and arterial invasion (BR-A). Results: The rates of NAT administration and resection were 35% and 79%, respectively. There were no significant differences in resection rates and prognoses between patients in the BR-PV and BR-A subgroups. NAT did not have a significant impact on prognosis according to intention-to-treat analysis. However, in patients who underwent surgical resection, NAT was independently associated with longer overall survival (OS). The median OS of patients who underwent resection after NAT (53.7 months) was significantly longer than that of patients who underwent upfront (17.8 months) or no resection (14.9 months). The rates of superior mesenteric or portal vein invasion, lymphatic invasion, venous invasion, and lymph node metastasis were significantly lower in patients who underwent resection after NAT than in those who underwent upfront resection despite similar baseline clinical profiles. Conclusions: Resection after NAT in patients with BRPC is associated with longer OS and lower rates of both invasion to the surrounding tissues and lymph node metastasis.

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