scholarly journals The predictors and patterns of the early recurrence of pancreatic ductal adenocarcinoma after pancreatectomy: the influence of pre- and post- operative adjuvant therapy

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hironobu Suto ◽  
Keiichi Okano ◽  
Minoru Oshima ◽  
Yasuhisa Ando ◽  
Shigeo Takahashi ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Local Recurrence ◽  
Adjuvant Therapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Preoperative Chemoradiotherapy ◽  
Distant Recurrence ◽  
Early Recurrence ◽  
Ductal Adenocarcinoma ◽  
Postoperative Adjuvant Chemotherapy ◽  
Early Local Recurrence

Abstract Background The perioperative factors predicting or influencing early pancreatic ductal adenocarcinoma recurrence are unclear. This study attempted to identify the predictive factors for early pancreatic ductal adenocarcinoma recurrence post-pancreatectomy and the influence of pre- and post- operative adjuvant therapy. Methods One hundred and fifteen patients undergoing curative resection for pancreatic ductal adenocarcinoma between 2000 and 2016 at our institution were retrospectively analyzed. Patients were divided into two groups: those who did (n = 34) and did not (n = 81) experience a recurrence within 6 months postoperatively. Results Multivariate analyses demonstrated postoperative CA19–9 de-normalization, no postoperative adjuvant chemotherapy, and serosal invasion were independent risk factors for early recurrence (P < 0.001, P = 0.001, and P = 0.010, respectively). A subgroup analysis showed patients with (n = 51) and without (n = 64) preoperative chemoradiotherapy had different predictors. Although postoperative adjuvant chemotherapy was not a significant indicator in patients with preoperative chemoradiotherapy, CA19–9 de-normalization and no postoperative adjuvant chemotherapy were significant indicators in patients without preoperative chemotherapy. Preoperative chemotherapy strongly prevented early local recurrence while postoperative adjuvant chemotherapy prevented early distant recurrence. Conclusions CA19–9 de-normalization was an important predictor of early recurrence of pancreatic ductal adenocarcinoma. Although postoperative adjuvant chemotherapy was an important preventive measure against early recurrence, particularly for distant recurrence, preoperative chemoradiotherapy could strongly prevent the early local recurrence of pancreatic ductal adenocarcinoma. These perioperative adjuvant therapies could have a complementary relationship.

scholarly journals The predictors and patterns of the early recurrence of pancreatic ductal adenocarcinoma after pancreatectomy: the influence of pre- and post- operative adjuvant therapy

2019 ◽  
Author(s):  
Hironobu Suto ◽  
Keiichi Okano ◽  
Minoru Oshima ◽  
Yasuhisa Ando ◽  
Shigeo Takahashi ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Local Recurrence ◽  
Adjuvant Therapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Preoperative Chemoradiotherapy ◽  
Distant Recurrence ◽  
Early Recurrence ◽  
Ductal Adenocarcinoma ◽  
Postoperative Adjuvant Chemotherapy ◽  
Early Local Recurrence

Abstract Background The perioperative factors predicting or influencing early pancreatic ductal adenocarcinoma recurrence are unclear. This study attempted to identify the predictive factors for early pancreatic ductal adenocarcinoma recurrence post-pancreatectomy and the influence of pre- and post- operative adjuvant therapy. Methods One hundred and fifteen patients undergoing curative resection for pancreatic ductal adenocarcinoma between 2000 and 2016 at our institution were retrospectively analyzed. Patients were divided into two groups: those who did (n=34) and did not (n=81) experience a recurrence within 6 months postoperatively. Results Multivariate analyses demonstrated postoperative CA19-9 de-normalization, no postoperative adjuvant chemotherapy, and serosal invasion were independent risk factors for early recurrence (P<0.001, P=0.001, and P=0.010, respectively). A subgroup analysis showed patients with (n=51) and without (n=64) preoperative chemoradiotherapy had different predictors. Although postoperative adjuvant chemotherapy was not a significant indicator in patients with preoperative chemoradiotherapy, CA19-9 de-normalization and no postoperative adjuvant chemotherapy were significant indicators in patients without preoperative chemotherapy. Preoperative chemotherapy strongly prevented early local recurrence while postoperative adjuvant chemotherapy prevented early distant recurrence. Conclusions CA19-9 de-normalization was an important predictor of early recurrence of pancreatic ductal adenocarcinoma. Although postoperative adjuvant chemotherapy was an important preventive measure against early recurrence, particularly for distant recurrence, preoperative chemoradiotherapy could strongly prevent the early local recurrence of pancreatic ductal adenocarcinoma. These perioperative adjuvant therapies could have a complementary relationship.

scholarly journals The predictors and patterns of the early recurrence of pancreatic ductal adenocarcinoma after pancreatectomy: the influence of pre- and post- operative adjuvant therapy

2019 ◽  
Author(s):  
Hironobu Suto ◽  
Keiichi Okano ◽  
Minoru Oshima ◽  
Yasuhisa Ando ◽  
Shigeo Takahashi ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Local Recurrence ◽  
Adjuvant Therapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Preoperative Chemoradiotherapy ◽  
Distant Recurrence ◽  
Early Recurrence ◽  
Ductal Adenocarcinoma ◽  
Postoperative Adjuvant Chemotherapy ◽  
Early Local Recurrence

Abstract Background The perioperative factors predicting or influencing early pancreatic ductal adenocarcinoma recurrence are unclear. This study attempted to identify the predictive factors for early pancreatic ductal adenocarcinoma recurrence post-pancreatectomy and the influence of pre- and post- operative adjuvant therapy. Methods One hundred and fifteen patients undergoing curative resection for pancreatic ductal adenocarcinoma between 2000 and 2016 at our institution were retrospectively analyzed. Patients were divided into two groups: those who did (n=34) and did not (n=81) experience a recurrence within 6 months postoperatively. Results Multivariate analyses demonstrated postoperative CA19-9 de-normalization, no postoperative adjuvant chemotherapy, and serosal invasion were independent risk factors for early recurrence (P<0.001, P=0.001, and P=0.010, respectively). A subgroup analysis showed patients with (n=51) and without (n=64) preoperative chemoradiotherapy had different predictors. Although postoperative adjuvant chemotherapy was not a significant indicator in patients with preoperative chemoradiotherapy, CA19-9 de-normalization and no postoperative adjuvant chemotherapy were significant indicators in patients without preoperative chemotherapy. Preoperative chemotherapy strongly prevented early local recurrence while postoperative adjuvant chemotherapy prevented early distant recurrence. Conclusions CA19-9 de-normalization was an important predictor of early recurrence of pancreatic ductal adenocarcinoma. Although postoperative adjuvant chemotherapy was an important preventive measure against early recurrence, particularly for distant recurrence, preoperative chemoradiotherapy could strongly prevent the early local recurrence of pancreatic ductal adenocarcinoma. These perioperative adjuvant therapies could have a complementary relationship.

scholarly journals The predictors and patterns of the early recurrence of pancreatic ductal adenocarcinoma after pancreatectomy: the influence of pre- and post- operative adjuvant therapy

2019 ◽  
Author(s):  
Hironobu Suto ◽  
Keiichi Okano ◽  
Minoru Oshima ◽  
Yasuhisa Ando ◽  
Shigeo Takahashi ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Local Recurrence ◽  
Adjuvant Therapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Preoperative Chemoradiotherapy ◽  
Distant Recurrence ◽  
Early Recurrence ◽  
Ductal Adenocarcinoma ◽  
Postoperative Adjuvant Chemotherapy ◽  
Early Local Recurrence

Abstract Background The perioperative factors predicting or influencing early pancreatic ductal adenocarcinoma recurrence are unclear. This study attempted to identify the predictive factors for early pancreatic ductal adenocarcinoma recurrence post-pancreatectomy and the influence of pre- and post- operative adjuvant therapy. Methods One hundred and fifteen patients undergoing curative resection for pancreatic ductal adenocarcinoma between 2000 and 2016 at our institution were retrospectively analyzed. Patients were divided into two groups: those who did (n=34) and did not (n=81) experience a recurrence within 6 months postoperatively. Results Multivariate analyses demonstrated postoperative CA19-9 de-normalization, no postoperative adjuvant chemotherapy, and serosal invasion were independent risk factors for early recurrence (P<0.001, P=0.001, and P=0.010, respectively). A subgroup analysis showed patients with (n=51) and without (n=64) preoperative chemoradiotherapy had different predictors. Although postoperative adjuvant chemotherapy was not a significant indicator in patients with preoperative chemoradiotherapy, CA19-9 de-normalization and no postoperative adjuvant chemotherapy were significant indicators in patients without preoperative chemotherapy. Preoperative chemotherapy strongly prevented early local recurrence while postoperative adjuvant chemotherapy prevented early distant recurrence. Conclusions CA19-9 de-normalization was an important predictor of early recurrence of pancreatic ductal adenocarcinoma. Although postoperative adjuvant chemotherapy was an important preventive measure against early recurrence, particularly for distant recurrence, preoperative chemoradiotherapy could strongly prevent the early local recurrence of pancreatic ductal adenocarcinoma. These perioperative adjuvant therapies could have a complementary relationship.

scholarly journals The predictors and patterns of the early recurrence of pancreatic ductal adenocarcinoma after pancreatectomy: the influence of pre- and post- operative adjuvant therapy: a single-center and retrospective analysis

2019 ◽  
Author(s):  
Hironobu Suto ◽  
Keiichi Okano ◽  
Minoru Oshima ◽  
Yasuhisa Ando ◽  
Shigeo Takahashi ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Adjuvant Therapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Preventive Measure ◽  
Preoperative Chemoradiotherapy ◽  
Distant Recurrence ◽  
Early Recurrence ◽  
Carbohydrate Antigen ◽  
Ductal Adenocarcinoma ◽  
Early Local Recurrence

Abstract Background The perioperative factors predicting or influencing early pancreatic ductal adenocarcinoma (PDAC) recurrence are unclear. This study attempted to identify the predictive factors for early PDAC recurrence post-pancreatectomy and the influence of pre- and post- operative adjuvant therapy. Methods One hundred and fifteen patients undergoing curative resection for PDAC between 2000 and 2016 at our institution were retrospectively analyzed. Patients were divided into two groups: those who did and did not experience PDAC recurrence within 6 months postoperatively. Results Thirty-four (30%) patients experienced early recurrence. Multivariate analyses demonstrated postoperative carbohydrate antigen 19-9 (CA19-9) de-normalization, no postoperative adjuvant chemotherapy (ACT), and serosal invasion were independent risk factors for early recurrence (P<0.001, P=0.001, and P=0.010, respectively). A subgroup analysis showed patients with (n=51) and without (n=64) preoperative chemoradiotherapy (CRT) had different predictors. Although postoperative ACT was not a significant indicator in patients with preoperative CRT, CA19-9 de-normalization and no postoperative ACT were significant indicators in patients without preoperative CRT. Preoperative CRT strongly prevented early local recurrence while postoperative ACT prevented early distant recurrence. Conclusions CA19-9 de-normalization was an important predictor of early recurrence of PDAC. Although postoperative ACT was an important preventive measure against early recurrence, particularly for distant recurrence, preoperative CRT might compensate for a lack of postoperative ACT. Preoperative CRT could strongly prevent the early local recurrence of PDAC. These perioperative adjuvant therapies could have a complementary relationship.

scholarly journals Benefits of Conversion Surgery after Multimodal Treatment for Unresectable Pancreatic Ductal Adenocarcinoma

Cancers ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1428
Author(s):  
Hiroaki Yanagimoto ◽  
Sohei Satoi ◽  
Tomohisa Yamamoto ◽  
So Yamaki ◽  
Satoshi Hirooka ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Adjuvant Chemotherapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Locally Advanced ◽  
Early Recurrence ◽  
Ductal Adenocarcinoma ◽  
Conversion Surgery ◽  
Postoperative Adjuvant Chemotherapy ◽  
Large Tumor

Background: Traditionally, the treatment options for unresectable locally advanced (UR-LA) and metastatic (UR-M) pancreatic ductal adenocarcinoma (PDAC) are palliative chemotherapy or chemoradiotherapy. The benefits of surgery for such patients remains unknown. The present study investigated clinical outcomes of patients undergoing conversion surgery (CS) after chemo(radiation)therapy for initially UR-PDAC. Methods: We recruited patients with UR-PDAC who underwent chemo(radiation)therapy for initially UR-PDAC between April 2006 and September 2017. We analyzed resectability of CS, predictive parameters for overall survival, and early recurrence (within six months). Results: A total of 468 patients (108 with UR-LA and 360 with UR-M PDAC) were enrolled in this study, of whom, 17 (15.7%) with UR-LA and 15 (4.2%) with UR-M underwent CS. The median survival time (MST) and five-year survival of patients who underwent CS was 37.2 months and 34%, respectively; significantly better than non-resected patients (nine months and 1%, respectively, p < 0.0001). MST did not differ according to UR-LA or UR-M (50.5 vs. 29.0 months, respectively, p = 0.53). Early recurrence after CS occurred in eight patients (18.8%). Lymph node metastasis, positive washing cytology, large tumor size (>35 mm), and lack of postoperative adjuvant chemotherapy were statistically significant predictive factors for early recurrence. Moreover, the site of pancreatic lesion and administration of postoperative adjuvant chemotherapy were statistically significant prognostic factors for overall survival in the patients undergoing CS. Conclusion: Conversion surgery offers benefits in terms of increase survival for initially UR-PDAC for patients who responded favorably to chemo(radiation)therapy when combined with postoperative adjuvant chemotherapy.

Preoperative chemoradiotherapy does not compromise the feasibility of adjuvant chemotherapy for patients with pancreatic ductal adenocarcinoma

Surgery Today ◽  
2016 ◽  
Vol 47 (2) ◽  
pp. 218-226 ◽  
Author(s):  
Hideo Tomihara ◽  
Hidetoshi Eguchi ◽  
Daisaku Yamada ◽  
Kunihito Gotoh ◽  
Koichi Kawamoto ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Preoperative Chemoradiotherapy ◽  
Ductal Adenocarcinoma

scholarly journals Pancreatic cancer stem cells may define tumor stroma characteristics and recurrence patterns in pancreatic ductal adenocarcinoma

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gokce Askan ◽  
Ibrahim Halil. Sahin ◽  
Joanne F. Chou ◽  
Aslihan Yavas ◽  
Marinela Capanu ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Specific Antigen ◽  
Tumor Stroma ◽  
Distant Recurrence ◽  
Ductal Adenocarcinoma ◽  
Rank Test ◽  
Stem Cell Markers ◽  
Significant Difference ◽  
The Impact

Abstract Background Herein, we investigate the relationship between pancreatic stem cell markers (PCSC markers), CD44, and epithelial-specific antigen (ESA), tumor stroma, and the impact on recurrence outcomes in pancreatic ductal adenocarcinoma (PDAC) patients. Methods PDAC patients who underwent surgical resection between 01/2012–06/2014 were identified. CD44 and ESA expression was assessed by immunohistochemistry. Stroma was classified as loose, moderate, and dense based on fibroblast content. Overall survival (OS) and relapse-free survival (RFS) were estimated using the Kaplan-Meier method and compared between subgroups by log-rank test. The association between PCSC markers and stroma type was assessed by Fisher’s exact test. Results N = 93 PDAC patients were identified. The number of PDAC patients with dense, moderate density, and loose stroma was 11 (12%), 51 (54%), and 31 (33%) respectively. PDAC with CD44+/ESA− had highest rate of loose stroma (63%) followed by PDAC CD44+/ESA+ (50%), PDAC CD44−/ESA+ (35%), CD44−/ESA− (9%) (p = 0.0033). Conversely, lack of CD44 and ESA expression was associated with the highest rate of moderate and dense stroma (91% p = 0.0033). No local recurrence was observed in patients with dense stroma and 9 had distant recurrence. The highest rate of cumulative local recurrence was observed in patients with loose stroma. No statistically significant difference in RFS and OS was observed among subgroups (P = 0.089). Conclusions These data indicate PCSCs may have an important role in stroma differentiation in PDAC. Our results further suggest that tumor stroma may influence the recurrence pattern in PDAC patients.

A High C-Reactive Protein Level on Postoperative Day 7 is Associated with Poor Survival of Patients with Pancreatic Ductal Adenocarcinoma after Resection

2021 ◽  
pp. 000313482110234
Author(s):  
Masaji Tani ◽  
Hiroya Iida ◽  
Hiromitsu Maehira ◽  
Haruki Mori ◽  
Toru Miyake ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Median Overall Survival ◽  
Cox Regression ◽  
Ductal Adenocarcinoma ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Retrospective View ◽  
Node Metastases ◽  
Common Malignancy

Introduction Pancreatic ductal adenocarcinoma (PDAC) is a common malignancy. While inflammation-related biomarkers influence patient survival after resection, it has not been known whether postoperative inflammations affect the survival of PDAC patients or not. Methods It was investigated whether the universal biomarkers on postoperative day (POD) 7 affect the survival of PDAC patients in the retrospective view, and univariate and multivariate analyses were performed via the Cox regression method. Results Overall, 108 consecutive patients underwent resection; 98 (90.7%) had T3 disease and 73 (67.6%) had lymph node metastases. Thirty-four patients (31.5%) experienced postoperative complications. Compared with preoperative values, the white blood cell count and C-reactive protein (CRP) level on POD 7 were significantly elevated ( P < .001 for both); conversely, the lymphocyte count was significantly reduced ( P < .001). Among 108 patients, 72 received adjuvant chemotherapy. The median overall survival was 21.0 months; the 5-year survival rate was 22.3%. On multivariate analysis, receiving adjuvant chemotherapy and low CRP levels on POD 7 (<7.6 mg/dL) were prognosticators of better survival. However, the CD classification was not a prognosticator of survival after resection. Conclusions Adjuvant chemotherapy and postoperative low CRP levels on POD 7 were prognosticators of better survival of PDAC patients after resection. Surgeons should be aware of managing postoperative infections because a high postoperative CRP level is related with unfavorable survival.

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