Adjuvant treatment in resected pancreatic adenocarcinoma: A retrospective analysis of survival and prognostic factors in 141 patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15104-15104
Author(s):  
A. Bujold ◽  
R. Létourneau ◽  
R. Lapointe ◽  
M. Dagenais ◽  
A. Roy ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Blood Loss ◽  
Retrospective Analysis ◽  
Pancreatic Adenocarcinoma ◽  
Adjuvant Treatment ◽  
Prospective Trial ◽  
Curative Intent ◽  
Free Survival ◽  
Treatment Groups ◽  
Ca 19.9

15104 Background: Resectable pancreatic adenocarcinoma (PA) remains highly lethal. It is debatable whether adjuvant therapy can improve prognosis. Furthermore, what treatment should be delivered and for whom it is indicated is still of controversy. Methods: Between 1992–2004, retrospective data from the 141 patients who had a PA resected with curative intent in our centres were reviewed. Adjuvant treatment was as follows: 41 had chemoradiation (CRT), 1 neoadjuvant CRT, 10 chemotherapy alone (CT), 1 radiotherapy alone, and for 7 adjuvant treatment is unknown. The other 81 patients were observed. Overall survival (OS), relapse-free survival (RFS), locoregional and distant failure-free survival (LRFFS and DFFS) were analysed according to published prognostic factors. Kaplan-Meier curves with log-rank tests and Chi-2 coefficients were computed for the analysis. Results: Median age at diagnosis was 61 years. Overall, 63% of the patients were node positive, 67% had lymphovascular invasion (LVI), 71% had elevated CA-19.9 values and 50% operative blood loss >550cc. Table 1 displays these prognostics factors by treatment groups. For the entire cohort, median OS was 16.9 months; 1-year and 3-year OS were 76% and 43% respectively. No influence of treatment arm was found on OS (p=0.71). Negative nodes, normal CA-19.9 values, absence of LVI and blood loss <=550cc had all a positive influence on OS (all p<0.05). RFS and DFFS were not affected by adjuvant treatment (p=0.61 and 0.68, resp.), but a lower LRFFS was associated with it (p=0.006). Conclusions: In this retrospective analysis, despite the imbalance of prognostic factors among treatment groups, toward more ill patients in CT and CRT arms, there is no difference in OS, DFS and DFFS between arms. Therefore, adjuvant treatment seems to counterbalance the effect of poor prognostic factors. A randomized prospective trial would be needed to further address the issue. [Table: see text] No significant financial relationships to disclose.

scholarly journals Predictors of adjuvant treatment for pancreatic adenocarcinoma at the population level

2016 ◽  
Vol 23 (5) ◽  
pp. 334 ◽  
Author(s):  
D.J. Kagedan ◽  
M.E. Dixon ◽  
R.S. Raju ◽  
Q. Li ◽  
M. Elmi ◽  
...  
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Adjuvant Treatment ◽  
Population Level ◽  
Universal Coverage ◽  
High Volume ◽  
Geographic Region ◽  
Administrative Databases ◽  
Resection Margins ◽  
Curative Intent ◽  
Comorbidity Burden

Background In the present study, we aimed to describe, at the population level, patterns of adjuvant treatment use after curative-intent resection for pancreatic adenocarcinoma (pcc) and to identify independent predictors of adjuvant treatment use.Methods In this observational cohort study, patients undergoing pcc resection in the province of Ontario (population 13 million) during 2005–2010 were identified using the provincial cancer registry and were linked to administrative databases that include all treatments received and outcomes experienced in the province. Patients were defined as having received chemotherapy (ctx), chemoradiation (crt), or observation (obs). Clinicopathologic factors associated with the use of ctx, crt, or obs were identified by chi-square test. Logistic regression analyses were used to identify independent predictors of adjuvant treatment versus obs, and ctx versus crt.Results Of the 397 patients included, 75.3% received adjuvant treatment (27.2% crt, 48.1% ctx) and 24.7% received obs. Within a single-payer health care system with universal coverage of costs for ctx and crt, substantial variation by geographic region was observed. Although the likelihood of receiving adjuvant treatment increased from 2005 to 2010 (p = 0.002), multivariate analysis revealed widespread variation between the treating hospitals (p = 0.001), and even between high-volume hepatopancreatobiliary hospitals (p = 0.0006). Younger age, positive lymph nodes, and positive surgical resection margins predicted an increased likelihood of receiving adjuvant treatment. Among patients receiving adjuvant treatment, positive margins and a low comorbidity burden were associated with crt compared with ctx.Conclusions Interinstitutional medical practice variation contributes significantly to differential patterns in the rate of adjuvant treatment for pcc. Whether such variation is warranted or unwarranted requires further investigation.

Results of upfront therapy for marginal zone lymphoma (MZL).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19510-e19510
Author(s):  
Fernando Cabanillas ◽  
Jose Luis Ortega ◽  
Noridza Rivera-Rodriguez ◽  
Blanca Rodriguez ◽  
Wandaly Ibis Pardo ◽  
...  
Keyword(s):  
Marginal Zone ◽  
Early Stage ◽  
Prospective Trial ◽  
Advanced Stage ◽  
Watch And Wait ◽  
Curative Intent ◽  
Free Survival ◽  
Group 2 ◽  
Group 1

e19510 Background: MZL is an indolent NHL composed of 3 subtypes: extranodal (MALT), splenic marginal zone (SMZL) and nodal marginal zone (NML). While MALT usually presents with early stage, the others frequently present with advanced disease. Early stage MALT is usually treated with XRT or antibiotics with ~85-90% failure free survival (FFS) and overall survival (OS), while for SMZL watch and wait or splenectomy (Spl) have been the mainstay of therapy. Spl leads to improvement but rarely to CR. 5 yr FFS and OS with Spl have been 45% and 80%. At 10 yrs FFS and OS are 22% and 62%. NML is usually managed with watch and wait. The 5 yr FFS and OS for NML have been 30% and 60%. Watch and wait and Spl are used in part because advanced MZL is considered incurable. Rituximab (R) as well fludarabine (F) are active in this disorder but traditionally are given after relapse. Methods: Instead of watch and wait or Spl, we have used upfront chemo with curative intent for SMZL and NML as well as for advanced MALT. For early stage MALT we used either XRT alone or antibiotics. We hereby report on 44 pts with MZL of which 31 were MALT, 9 SMZL, 4 NMZL. For the purpose of analysis we divided the pts in 2 groups. Group 1 consists of 22 early stage MALT who were all treated with either XRT (N=17) or antibiotics +/- surgery (N=5). Group 2 consists of 22 cases who were treated with chemo alone. This group is made up of 9 MALT (4 advanced stage, 3 early stage but with transformation, 2 early stage but in whom XRT was contraindicated), 9 advanced stage SMZL, 4 NML. Chemo for group 2 consisted of F, mitoxantrone, dexamethasone, rituximab (FND-R) (N=14) or R-CHOP (N=8). Maintenance R was used in 70% of group 2. Results: Of the whole group, 100% were CR and only 2 relapsed at 70 and 75 months; both relapses were stage I MALT and had received XRT only. Both were salvaged with FND-R and remain NED 27 and 39 months from relapse. At 10 yrs, FFS was 80% and OS=100%. None of the 22 in group 2 have relapsed. The long-term toxicity has been acceptable. Conclusions: The excellent FFS and OS using upfront chemotherapy in group 2, suggests that this disorder is curable and our results should be confirmed in a prospective trial. For those with early stage MALT, XRT alone +/- antibiotics and when necessary salvage with FND-R, should be tested.

Adjuvant therapy in pancreatic adenocarcinoma: A systemic review and meta-analysis.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 330-330
Author(s):  
Kazi Jannatun Nahar ◽  
David Chan ◽  
Anubhav Mittal ◽  
Jaswinder S. Samra ◽  
Thomas Hugh ◽  
...  
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Adjuvant Treatment ◽  
Meta Analysis ◽  
Systemic Review ◽  
Free Survival ◽  
Hazard Ratios ◽  
Cochrane Database ◽  
Significant Difference ◽  
Grade 3

330 Background: The “optimal” adjuvant treatment in pancreatic cancer remains undetermined. Chemotherapy (chemo) such as gemcitabine (Gem), 5-fluorouracil (5-FU) and chemo-radiotherapy (chemoRT) with either Gem or 5-FU have been investigated in trials. We performed a systematic review and meta-analysis to determine the overall efficacy of adjuvant treatment. Methods: We searched databases (PubMed, Medline, Cochrane database) and major conference proceedings up until August 2015 for randomized trials comparing chemo or chemoRT versus (vs) observation, two different chemo regimens and chemoRT vs chemo. Primary end point was overall survival (OS); secondary end points were relapse free survival (RFS), grade 3/4 toxic effects and quality of life (QoL). We performed meta-analysis as per the PRISMA guidelines; hazard ratios (HR) for OS and RFS were pooled with random-effects modelling. Results: Fifteen trials were identified evaluating 4348 patients. For trials comparing chemo to observation (7 trials, n = 1383) the OS HR was 0.77 (95% CI 0.67-0.89, p = 0.001) and PFS HR 0.73 (95% CI 0.53-1.01, p = 0.06) both favouring chemo. For trials investigating Gem (2 trials, n = 472), OS was improved with HR 0.76 (95% CI 0.63 -0.92, p = 0.006) as was RFS (HR 0.56, 95% CI 0.46-0.68, p < 0.00001). For trials investigating agents other than Gem (5 trials, n = 911), OS was improved with HR 0.79 (95% CI 0.63-0.99, p = 0.04), but RFS was not (2 trials only, HR 1.00, 95% CI 0.73-1.37, p = 0.99). Five trials (n = 1832) compared different chemo regimens to Gem in each case; pooled OS HR was 0.90 (95% CI 0.65-1.25, p = 0.54) and RFS HR 0.88 (95% CI 0.67-1.15, p = 0.35). Insufficient data was available to pool grade 3/4 toxicity for chemo vs observation trials; no significant difference was found in incidence of overall grade 3/4 toxicity for trials comparing two chemo regimens (OR 0.98, 95% CI 0.39-2.47, p = 0.96). QoL data was available in 3 trials (ESPAC-1, ESPAC-3, CapRi) with no significant differences noted. Conclusions: Adjuvant chemo vs no chemo for resected pancreatic adenocarcinoma improves OS and RFS. Adjuvant ChemoRT vs no treatment is not beneficial. Overall, novel chemo regimens have not been shown to be superior to Gem. Reporting of QoL is inadequate to make any conclusion.

scholarly journals Differences in Prognostic Factors and Recurrence Patterns After Curative-Intent Resection of Perihilar and Distal Cholangiocarcinomas

2019 ◽  
Vol 109 (3) ◽  
pp. 219-227 ◽  
Author(s):  
V. Sallinen ◽  
J. Sirén ◽  
H. Mäkisalo ◽  
T. E. Lehtimäki ◽  
E. Lantto ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Confidence Interval ◽  
Disease Free Survival ◽  
Hazard Ratio ◽  
Perihilar Cholangiocarcinoma ◽  
Curative Intent ◽  
Distal Cholangiocarcinoma ◽  
Free Survival ◽  
Disease Free

Background: Perihilar cholangiocarcinoma and distal cholangiocarcinoma arise from the same tissue but require different surgical treatment methods. It remains unclear whether these cholangiocarcinoma types have different outcomes, prognostic factors, and/or recurrence patterns. Methods: This retrospective study evaluated patients who underwent curative-intent resection for perihilar cholangiocarcinoma or distal cholangiocarcinoma at a tertiary academic hospital during 2000–2015. Survival and prognostic factors were identified using Kaplan–Meier and Cox regression analyses. Results: The 90-day mortality rates were 0% for perihilar cholangiocarcinoma (36 patients) and 4% for distal cholangiocarcinoma (47 patients). There were no significant differences between perihilar cholangiocarcinoma or distal cholangiocarcinoma in median overall survival (30.9 vs 40.4 months) or median disease-free survival (14.2 vs 21.4 months). Among perihilar cholangiocarcinoma patients, age > 65 years was an independent predictor of poorer overall survival (hazard ratio: 2.45, 95% confidence interval: 1.07–5.64), while requiring bile duct re-resection was an independent predictor of disease-free survival (hazard ratio: 2.76, 95% confidence interval: 1.01–7.51). Among distal cholangiocarcinoma patients, a pN1 category independently predicted poorer overall survival (hazard ratio: 3.40, 95% confidence interval: 1.14–10.11), while preoperative CA19-9 levels >30 U/mL (hazard ratio: 2.51, 95% confidence interval: 1.09–5.79) and pN1 category (hazard ratio: 2.51, 95% confidence interval: 1.09–5.79) predicted a shorter disease-free survival. Local recurrence was more common with perihilar cholangiocarcinoma (50% of recurrences), while multiple synchronous sites were more common for distal cholangiocarcinoma (41% of recurrences). Conclusion: Perihilar cholangiocarcinoma and distal cholangiocarcinoma patients have similar survival outcomes. However, local control appears to be more prognostic for perihilar cholangiocarcinoma patients, while positive lymph nodes are critical prognostic factor for distal cholangiocarcinoma patients.

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