Benefits of Conversion Surgery after Multimodal Treatment for Unresectable Pancreatic Ductal Adenocarcinoma
Abstract
:1. Introduction
2. Patients and Methods
2.1. Study Population
2.2. Data Collection
2.3. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Best Response After First-Line Treatment
3.3. Conversion Surgery
3.4. Survival Analysis
3.5. Comparison between Patients with Unresectable Locally Advanced and Metastatic Disease
3.6. Recurrence-Free Survival
3.7. Prognostic Factors for Overall Survival Among Patients Who Underwent Conversion Surgery
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Variables | UR-LA (n = 108) | UR-M (n = 360) | p-Value |
---|---|---|---|
Age (years), median (range) | 69(38–84) | 67(33–86) | 0.15 |
Male/female, n (%) | 54(50)/54(50) | 210(58.3)/150(41.7) | 0.12 |
ECOG PS, n (%): 0/1/2 | 86(79.6)/18(16.6)/4(3.8) | 218(60.5)/127(35.2)/15(4.2) | 0.0004 |
Tumor location, n (%) | |||
Head/Body-tail | 73(67.6)/35(32.4) | 148(41.1)/212(58.9) | <0.0001 |
Tumor size (mm) | 38(20-76) | 40(15-83) | 0.062 |
CA19-9 (U/L) | 237(1.1-8949) | 580(1-12219) | <0.0001 |
Extent of disease, n (%) | |||
Localized | |||
Metastatic site | 108(100) | ||
Liver | 193(53.6) | ||
Peritoneum | 123(34.2) | ||
Lung/LN/Other | 15(4.2)/23(6.4)/6(1.6) | ||
Treatment, n (%) | |||
GEM | 17(15.7) | 125(34.7) | |
GEM + Erlotinib | 2(1.9) | 14(3.9) | |
S-1 | 5(4.6) | 38(10.6) | |
GS | 31(28.7) | 42(11.6) | |
GnP | 13(12.0) | 63(17.5) | |
FOLFIRINOX | 12(11.1) | 21(5.8) | |
S-1or GnP or GS plus PTX (i.p. + i.v.) | 0(0) | 43(11.9) | |
Chemoradiotherapy | 27(25) | 10(2.8) | |
Other | 1(0.9) | 4(1.1) |
Variables | n = 32 | UR-LA (n = 17) | UR-M (n = 15) | p-Value |
---|---|---|---|---|
Age(years), median (range) | 66 (36–84) | 65 (38–75) | 69 (50–83) | 0.135 |
Male: Female, n (%) | 14 (44): 18 (56) | 7(41):10(59) | 7(47):8(53) | 0.754 |
Ph: Pbt, n (%) | 14 (44): 18 (56) | 9 (53): 8 (47) | 5 (33): 10 (67) | 0.264 |
Tumor Size(mm), median (range) | 36 (25–74) | 35 (25–55) | 40 (27–74) | 0.747 |
Mets site: None:L:P, n (%) | 17 (53): 4 (13):11 (34) | 17 (100): 0 (0):0 (0) | 0(0): 4 (27):11 (73) | <0.0001 |
CA19-9; U/mL, median (range) | 278 (1.2–3400) | 126 (8.4–2200) | 984 (6.6–1953) | 0.209 |
Preoperative CA19-9 | 29.1(1.0–181.9) | 39.7(1.0–181.9) | 19(1.0–73.9) | 0.42 |
Primary Treatment | ||||
GEM or GS | 7 | 4 | 3 | |
GEM + nab-PTX (GnP) | 7 | 4 | 3 | |
S1 or GEM based + ip PTX | 8 | 0 | 8 | |
FOLFIRINOX | 3 | 3 | 0 | |
GEM or S-1 or GS + RT (50.4 Gy) | 7 | 6 | 1 | |
Radiation, n (%) | 13(41) | 11(65) | 2(13) | 0.002 |
Pretreatment period to op; (median, range) | 9.5(4–28) | 10 (4–28) | 9 (6–16) | 0.6207 |
RECIST (CR: PR), n (%) | 1 (3.1%): 31(96.9%) | 0(0):17(100) | 1(7):14(63) | 0.153 |
Operative time(min) | 454(223–866) | 441(223–655) | 467(227–866) | 0.36 |
Intraoperative blood loss(mL) | 1229(207–6301) | 1087(237–2931) | 1255(207–6301) | 0.58 |
Blood transfusion (U) | 0(0–12) | 0(0–7) | 0(0–12) | 0.42 |
PD: DP: DP-CAR: TP, n (%) | 13 (40): 11(34): 4(13): 4(13) | 9(52):4(24):2(12):2(12) | 5(33):7(47):2(13):1(7) | 0.257 |
-CHA/CA/PV resection- | -3(9)/4(13)/15(47)- | -3(18)/2(12)/9(52)- | -0(0)/2(13)/6(40)- | |
Residual tumor (R0: R1), n (%) | 29(91): 3(9) | 16(94):1(6) | 13(87):2(13) | 0.471 |
Postop comp/Mortality (%) | 8(25)/0(0) | 2(12)/0(0) | 6(40)/0(0) | 0.066/0 |
Hospital stay (median, range) | 14 (7–114) | 11 (7–41) | 14 (7–114) | 0.271 |
Evans (I/IIa/IIb/III/IV, (%)) | 1(3)/12(38)/10(31)/8(25)/1 (3) | 1(6)/7(41)/5(29)/4(24)/0 (0) | 0(0)/5(33)/5(33)/4 (27)/1(7) | 0.695 |
Variables | Univariate Analysis | p-Value | Multivariate Analysis | p-Value | ||
---|---|---|---|---|---|---|
HR | 95% CI | HR | 95% CI | |||
UR-M vs. UR-LA | 1.16 | 0.19–7.37 | 0.87 | 0.07 | ||
Pbt vs. Ph | 4.99 | 0.68–102 | 0.12 | 0.07 | ||
Tumor Size (>35 mm vs. <35 mm) | 5.83 | 0–0.40 | 0.007 | 2.16 | 0–2.31 | 0.003 |
Pretreatment period (<8 m vs. >8 m) | 2.22 | 0.29–46.22 | 0.47 | 0.38 | ||
Reduction of CA19-9 or DUPAN-2 (<70% vs. >70%) | 5.99 | 0.80–50.84 | 0.08 | 0.38 | ||
LN mets (+) vs. (−) | 4.29 | 0.58–88.2 | 0.16 | 4.5 | 0.40–11.10 | 0.01 |
R0 vs. R1 | 3.11 | 0–4.00 | 0.25 | 0.99 | ||
CY (+) vs. (−) | 2.74 | 0.31–20.3 | 0.34 | 1.11 | 0.56–1.70 | <0.0001 |
Evans I-IIa vs. IIb-IV | 1.47 | 0.24–11.9 | 0.68 | 0.46 | ||
Adjuvant Tx (−) vs. (+) | 1.36 | 0.16–8.74 | 0.76 | 2.96 | 0.32–3.06 | 0.0029 |
Variables | Univariate Analysis | p-Value | Multivariate Analysis | p-Value | ||
---|---|---|---|---|---|---|
HR | 95% CI | HR | 95% CI | |||
UR-M vs. UR-LA | 1.34 | 0.53–3.54 | 0.53 | 0.44 | ||
Pbt vs. Ph | 1.24 | 0.49–3.40 | 0.65 | 14.14 | 1.86–182 | 0.0092 |
Tumor Size (>35 mm vs. <35 mm) | 2.47 | 0.89–7.53 | 0.08 | 0.61 | ||
Pretreatment period (<8 m vs. >8 m) | 0.79 | 0.22–2.25 | 0.68 | 0.27 | ||
Reduction of CA19-9 or DUPAN-2 (<70% vs. >70%) | 1.08 | 0.38–3.89 | 0.89 | 0.086 | ||
LN mets (+) vs. (−) | 1.07 | 0.38–2.86 | 0.89 | 0.5 | ||
R1 vs. R0 | 1.76 | 0.27–6.41 | 0.49 | 0.19 | ||
CY (+) vs. (−) | 2.91 | 0.98–7.71 | 0.05 | 0.08 | ||
Evans I-IIa vs. IIb-IV | 1.77 | 0.65–4.71 | 0.26 | 0.05 | ||
Adjuvant Tx (−) vs. (+) | 4.63 | 1.76–12.13 | 0.0024 | 367.22 | 20.16–15093 | <0.0001 |
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Share and Cite
Yanagimoto, H.; Satoi, S.; Yamamoto, T.; Yamaki, S.; Hirooka, S.; Kotsuka, M.; Ryota, H.; Ishida, M.; Matsui, Y.; Sekimoto, M. Benefits of Conversion Surgery after Multimodal Treatment for Unresectable Pancreatic Ductal Adenocarcinoma. Cancers 2020, 12, 1428. https://doi.org/10.3390/cancers12061428
Yanagimoto H, Satoi S, Yamamoto T, Yamaki S, Hirooka S, Kotsuka M, Ryota H, Ishida M, Matsui Y, Sekimoto M. Benefits of Conversion Surgery after Multimodal Treatment for Unresectable Pancreatic Ductal Adenocarcinoma. Cancers. 2020; 12(6):1428. https://doi.org/10.3390/cancers12061428
Chicago/Turabian StyleYanagimoto, Hiroaki, Sohei Satoi, Tomohisa Yamamoto, So Yamaki, Satoshi Hirooka, Masaya Kotsuka, Hironori Ryota, Mitsuaki Ishida, Yoichi Matsui, and Mitsugu Sekimoto. 2020. "Benefits of Conversion Surgery after Multimodal Treatment for Unresectable Pancreatic Ductal Adenocarcinoma" Cancers 12, no. 6: 1428. https://doi.org/10.3390/cancers12061428