scholarly journals Hs-CRP, albumin and CA19-9 after neoadjuvant therapy predict postoperative survival in borderline resectable pancreatic ductal adenocarcinoma

HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S373
Author(s):  
A. Nurmi ◽  
H. Mustonen ◽  
U.H. Stenman ◽  
C. Haglund ◽  
H. Seppänen
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Neoadjuvant Therapy ◽  
Postoperative Survival ◽  
Ductal Adenocarcinoma ◽  
Borderline Resectable ◽  
Hs Crp

scholarly journals Neoadjuvant Treatment for Borderline Resectable Pancreatic Ductal Adenocarcinoma

2018 ◽  
Vol 36 (6) ◽  
pp. 455-461 ◽  
Author(s):  
Benedikt Kaufmann ◽  
Daniel Hartmann ◽  
Jan G. D’Haese ◽  
Pavel Stupakov ◽  
Dejan Radenkovic ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Neoadjuvant Therapy ◽  
Neoadjuvant Treatment ◽  
Ductal Adenocarcinoma ◽  
Preoperative Treatment ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Treatment Regimens ◽  
Dismal Prognosis ◽  
First Choice

One of the main reasons for the dismal prognosis of pancreatic ductal adenocarcinoma (PDAC) is its late diagnosis. At the time of presentation, only approximately 15–20% of all patients with PDAC are considered resectable and around 30% are considered borderline resectable. A surgical approach, which is the only curative option, is limited in borderline resectable patients by local involvement of surrounding structures. In borderline resectable pancreatic cancer (BRPC), neoadjuvant treatment regimens have been introduced with the rationale to downstage and downsize the tumor in order to enable resection and eliminate ­microscopic distant metastases. However, there are no official guidelines for the preoperative treatment of BRPC. In the majority of cases, patients are administered ­Gemcitabine-based or FOLFIRINOX-based chemotherapy regimens with or without radiation. Radiologic restaging after neoadjuvant therapy has to be judged with caution when it comes to predict tumor response and resectability, since inflammation induced by neoadjuvant therapy may mimic solid tumor. Patients who do not show any disease progression during neoadjuvant therapy should be offered surgical exploration, since a high percentage is likely to undergo resection with negative margins (R0) and, thus, achieve improved overall survival although imaging judged it unlikely. Despite the promising new approaches of neoadjuvant treatment regimens during the last 2 decades, surgery remains the first choice if the tumor appears to be primary resectable at the time of diagnosis. At present, there are no international guidelines regarding the preoperative treatment of BRPC. Therefore, in order to standardize and adjust neoadjuvant treatment in the future, new guidelines have to be determined on the basis of upcoming prospective randomized studies.

scholarly journals Neoadjuvant Therapy for Borderline Resectable Pancreatic Ductal Adenocarcinoma (PDA) Involving a High Volume Pancreatic Centre in Ireland

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S717-S718
Author(s):  
R. Abdul Rahman ◽  
L. Bonanni ◽  
S. O'Sullivan ◽  
M. Greally ◽  
A.N. Patel ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Neoadjuvant Therapy ◽  
High Volume ◽  
Ductal Adenocarcinoma ◽  
Borderline Resectable

Changes in CRP and CA19-9 during Preoperative Oncological Therapy Predict Postoperative Survival in Pancreatic Ductal Adenocarcinoma

Oncology ◽  
2021 ◽  
pp. 1-13
Author(s):  
Anna Maria Nurmi ◽  
Harri Mustonen ◽  
Caj Haglund ◽  
Hanna Seppänen
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Median Survival ◽  
Postoperative Outcome ◽  
University Hospital ◽  
Postoperative Survival ◽  
Ductal Adenocarcinoma ◽  
Preoperative Treatment ◽  
Borderline Resectable ◽  
Oncological Therapy ◽  
The Impact

<b><i>Introduction:</i></b> Tumor and systemic inflammatory markers predict survival. This retrospective study aimed to explore the changes in CRP, CA19-9, and other routine laboratory tests during preoperative oncological therapy as prognostic factors in pancreatic ductal adenocarcinoma (PDAC). <b><i>Methods:</i></b> Between 2000 and 2016, 68 borderline resectable PDAC patients received preoperative oncological therapy and underwent subsequent surgery at Helsinki University Hospital, Finland. We investigated changes in CRP, CA19-9, CEA, albumin, leukocytes, bilirubin, and platelets and examined the impact on survival. <b><i>Results:</i></b> In the multivariate analysis, CRP remaining at ≥3 mg/L after preoperative oncological therapy predicted a poorer postoperative outcome when compared to CRP decreasing to or remaining at &#x3c;3 mg/L (hazard ratio [HR] 2.766, 95% confidence interval [CI]: 1.300–5.885, <i>p</i> = 0.008). Furthermore, a CA19-9 decrease &#x3e;90% during preoperative treatment predicted a favorable postoperative outcome (HR 0.297, 95% CI: 0.124–0.708, <i>p</i> = 0.006). In the Kaplan-Meier analysis, the median survival for patients with CRP remaining at &#x3c;3 mg/L was longer than among patients with an increased CRP level at ≥3 mg/L (42 months vs. 24 months, <i>p</i> = 0.001). Patients with a CA19-9 decrease &#x3e;90% or level normalization (to ≤37 kU/L) during preoperative treatment exhibited a median survival of 47 months; those with a 50–90% decrease, 15 months; and those with a &#x3c;50% decrease, 17 months (<i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Changes in CRP and CA19-9 during preoperative oncological therapy predict postoperative survival.

scholarly journals neoadjuvant therapy for borderline resectable pancreatic ductal adenocarcinoma (PDA) involving a high volume pancreatic centre in Ireland

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S976
Author(s):  
R. Abdul Rahman ◽  
L. Bonanni ◽  
S. O'Sullivan ◽  
M. Greally ◽  
A.N. Patel ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Neoadjuvant Therapy ◽  
High Volume ◽  
Ductal Adenocarcinoma ◽  
Borderline Resectable

scholarly journals Neoadjuvant therapy in borderline resectable pancreatic ductal adenocarcinoma: A single institution review

2014 ◽  
Vol 4 (4) ◽  
Author(s):  
Shilpen Patel ◽  
Sanjay Chandrasekaran ◽  
Gary N. Mann ◽  
Suchitra Chandrasekaran ◽  
Felicia R. Lucas ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Neoadjuvant Therapy ◽  
Ductal Adenocarcinoma ◽  
Single Institution ◽  
Borderline Resectable

Predicting Surgical Margins in Patients With Borderline Resectable and Locally Advanced Pancreatic Cancer Undergoing Resection

2021 ◽  
pp. 000313482110111
Author(s):  
Weizheng Ren ◽  
Dimitrios Xourafas ◽  
Stanley W. Ashley ◽  
Thomas E. Clancy
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Ductal Adenocarcinoma ◽  
Resection Margins ◽  
Borderline Resectable ◽  
Stepwise Selection ◽  
R1 Resection ◽  
Positive Resection Margins

Background Many patients with borderline resectable/locally advanced pancreatic ductal adenocarcinoma (borderline resectable [BR]/locally advanced [LA] pancreatic ductal adenocarcinoma [PDAC]) undergoing resection will have positive resection margins (R1), which is associated with poor prognosis. It might be useful to preoperatively predict the margin (R) status. Methods Data from patients with BR/LA PDAC who underwent a pancreatectomy between 2008 and 2018 at Brigham and Women’s Hospital were retrospectively reviewed. Logistic regression analysis was used to evaluate the association between R status and relevant preoperative factors. Significant predictors of R1 resection on univariate analysis ( P < .1) were entered into a stepwise selection using the Akaike information criterion to define the final model. Results A total of 142 patients with BR/LA PDAC were included in the analysis, 60(42.3%) had R1 resections. In stepwise selection, the following factors were identified as positive predictors of an R1 resection: evidence of lymphadenopathy at diagnosis (OR = 2.06, 95% CI: 0.99-4.36, P = .056), the need for pancreaticoduodenectomy (OR = 3.81, 96% CI: 1.15-15.70, P = .040), extent of portal vein/superior mesenteric vein involvement at restaging (<180°, OR = 3.57, 95% CI: 1.00-17.00, P = .069, ≥180°, OR = 7,32, 95% CI: 1.75-39.87, P = .010), stable CA 19-9 serum levels (less than 50% decrease from diagnosis to restaging, OR = 2.27, 95% CI: 0.84-6.36 P = .107), and no preoperative FOLFIRINOX (OR = 2.17, 95% CI: 0.86-5.64, P = .103). The prognostic nomogram based on this model yielded a probability of achieving an R1 resection ranging from <5% (0 factors) to >70% (all 5 factors). Conclusions Relevant preoperative clinicopathological characteristics accurately predict positive resection margins in patients with BR/LA PDAC before resection. With further development, this model might be used to preoperatively guide surgical decision-making in patients with BR/LA PDAC.

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