Clinical features and outcomes of colloid carcinoma of pancreas compared to pancreatic ductal adenocarcinoma.

e16259 Background: Colloid carcinoma (CC) of the pancreas is a rare histopathological subtype of ductal adenocarcinoma (PDAC), with poorly defined prognostic factors and therapeutic outcomes. The aim of this study is to characterize the clinicopathological features and evaluate the overall survival (OS) and prognostic factors of patients with pancreatic CC using National Cancer Database (NCDB). Methods: Patients diagnosed with CC of the pancreas and PDAC between 2004 and 2016 were identified from the NCDB using ICD-O-3 morphology (8480/3 for CC and 8140/3 for PDAC) and topography codes (C25). Univariate and multivariable analyses were conducted and Kaplan-Meier analysis and Cox proportional hazards models were used to perform OS analysis. Results: A total of 56,846 patients met the inclusion criteria for the final analysis. Of the total population included, 2,430 patients (4.3%) had CC and 54,416 patients (95.7%) had PDAC. For both, CC and PDAC, there was a male preponderance (52.0%, 52.5%), Caucasians (85.1%, 84%), occurrence above the age of 70 (39.2%, 38.2%), and the most common primary site was the head of the pancreas (50.5%, 53%). For CC, the percentage of pathologic stage III colloid pancreas cancer appeared the lowest (3.5%, 85 patients), compared to stage I (16.7%), stage II (37.8%), and stage IV (42.1%). While in PDAC, the percentage of pathologic stage I (5.94%) and stage III (4.44%) patients was lower than stage II (37.21%) and IV (52.41%). CC and PDAC more frequently presented with < 5cm tumor, at academic or research cancer centers, and diagnosed between 2009 and 2013 compared to 2004–2008 ( p< 0.001). For both CC and PDAC, the majority underwent surgical resection (58%, 53%), systemic chemotherapy (57.8%, 63%) and did not receive radiotherapy (78.8%, 77.6%). A positive surgical margin on pathologic evaluation was associated with worse outcomes for CC and PDAC in both univariate and multivariate analysis (HR 1.61; 1.56–1.66; p< 0.001 and HR 1.43; 1.38–1.48, p< 0.001). CC had a better 1-year overall survival (OS) in all stages compared to PDAC (p < 0.001). In multivariate analysis, mucinous carcinoma histology, female sex, diagnosis between 2004 and 2009, well/moderately differentiated histology, chemotherapy, age at diagnosis less than 60, radiation therapy after surgery, and local surgical procedure of primary site and pancreatectomy (p < 0.001) were associated with better OS compared to PDAC. Colloid histology was associated with better 1-year overall survival (OS) in all stages compared to PDAC (p < 0.001). Conclusions: Colloid carcinoma of pancreas is associated with a better overall survival as compared to pancreatic ductal adenocarcinoma. This is the largest study to address the clinical features and outcomes of colloid carcinoma of pancreas.

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Sites of Extranodal Involvement Are Prognostic in Patients with Stage 1 Follicular Lymphoma: An Analysis of the Surveillance, Epidemiology and End Results Database

Blood ◽

10.1182/blood.v124.21.1670.1670 ◽

2014 ◽

Vol 124 (21) ◽

pp. 1670-1670

Author(s):

Aditi Shastri ◽

Yiting Yu ◽

Amit Verma ◽

Stefan Klaus Barta

Keyword(s):

Overall Survival ◽

Nervous System ◽

Multivariate Analysis ◽

Lymph Node ◽

Musculoskeletal System ◽

Primary Site ◽

Stage I ◽

Aggressive Treatment ◽

Primary Disease ◽

Kaplan Meier

Abstract Background: Follicular lymphoma (FL) is the most common indolent B cell lymphoma with a rising incidence. Approximately 26% of patients with FL present with stage I disease. Although international consensus guidelines recommend radiotherapy for these patients, a recent survey of the National Lymphocare Study demonstrated that adherence to the standard is low with less than one third of patients treated with radiotherapy, whereas the rest were only observed, received single-agent rituximab, or a combination of rituximab with chemotherapy +/- subsequent radiotherapy. There is evidence to suggest that extranodal sites of involvement are associated with better/worse outcomes in other lymphomas (DLBCL, MCL). Hence, we examined the association between primary site of disease and survival in patients with Stage I FL to identify subgroups of patients that have distinct characteristics and could potentially benefit from early and/or more aggressive treatment. Methods: We analyzed the United States SEER database from 1983 to 2011. Direct case listings were extracted by SEER*Stat software, version 8.1.5, released March 31,2014. All histologically confirmed, Stage I FL cases, age > 18 years, with active follow-up and only a single primary tumor were included in the analysis. Overall survival (OS) estimates for each primary site were calculated using the Kaplan-Meier method and log rank test. We assessed the impact of primary disease site on OS using Cox proportional hazards models adjusted for age, sex, race, radiotherapy, surgery and era of diagnosis (pre-rituximab era: Õ83-Õ98 vs. rituximab era: Õ99-Õ11). Calculations were performed using SAS, version 9.3. Results: We analyzed 9931 total patients, 25% of patients presented with an extranodal primary site. The most common extranodal primary sites were the integumentary system (8%), GI tract (6.4%) and the head & neck region (5.6%). In univariate analysis, Stage I FL of the integumentary system was associated with better OS than lymph node (LN) primary disease (HR 0.74, 95% CI 0.63 to 0.59). Primary site FL of the respiratory system (HR 1.69, CI 1.18 to 2.4), musculoskeletal system (HR 2, CI 1.37 to 3) and nervous system (HR 1.9, CI 1.37 to 2.68) were significantly associated with worse overall survival than lymph node primary disease. In multivariate analysis, only integumentary disease was associated with better OS (HR 0.77, CI 0.66 to 0.9) while primary site FL of the nervous system (HR 2.4, CI 1.72 to 3.38) and the musculoskeletal system (HR 2.14, CI 1.44 to 3.18) were associated with worse overall survival than lymph node primary disease. Patients treated in the rituximab era had a better OS on multivariate analysis than if treated in the pre-rituximab era (p<0.0001). Female sex was associated with better survival while older age at diagnosis was associated with worse survival (p<0.0001). In multivariate analysis, patients who received surgery or radiation had better survival than those that did not receive any therapy and Whites had better survival than Blacks (both p<0.0001). Conclusions: Primary site of disease may be an important prognostic factor for patients with early stage FL as demonstrated by this population-based study. Patients with Stage I FL of the integumentary system had a significantly better outcome than primary nodal disease. Musculoskeletal and nervous system primary sites had a significantly worse survival than primary nodal sites. These subsets of patients may benefit from early, aggressive treatment. Primary site may correlate with certain biological characteristics associated with disease behavior and pathogenesis and needs further evaluation. Overall survival was significantly better in the rituximab era. Figure 1. Kaplan Meier Curve demonstrating OS of integumentary system vs. lymph node primary site (180 months vs. 170 months, p <0.0001), nervous system vs. lymph node primary site (95 months vs. 170 months, p <0.0001) and musculoskeletal system vs. lymph node primary site (96 months vs. 170 months, p <0.0001). Figure 1. Kaplan Meier Curve demonstrating OS of integumentary system vs. lymph node primary site (180 months vs. 170 months, p <0.0001), nervous system vs. lymph node primary site (95 months vs. 170 months, p <0.0001) and musculoskeletal system vs. lymph node primary site (96 months vs. 170 months, p <0.0001). Disclosures No relevant conflicts of interest to declare.

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Prognostic value of hemoglobin in natural killer cell lymphoma

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.17557 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 17557-17557

Author(s):

J. Xiao ◽

T. Lin ◽

Y. Cao ◽

X. Fu ◽

C. Guo ◽

...

Keyword(s):

Overall Survival ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Natural Killer ◽

Prognostic Value ◽

Nk Cell ◽

Cell Lymphoma ◽

Southern China ◽

Univariate Analysis ◽

Stage I

17557 Background: Natural Killer (NK) cell lymphoma is a group of increasingly recognized but poorly defined disease entities. This study investigated its clinical features and prognostic factors for southern China population. Methods: Patients with pathologically confirmed NK cell lymphoma in one center since 1999 to 2004 were included. Central histological and immunohistochemical review was undertaken to every case. The major study endpoint was overall survival. Survival curves were estimated by the Kaplan-Meier method. Detailed clinical, pathological and laboratory data were included in univariate analysis and statistically significant factors in univariate analysis were then included in multivariate analysis. Results: Totally 64 eligible patients were identified. Of these, 59 patients were extranodal NK cell lymphoma nasal type, 3 patients were aggressive NK cell lymphoma and 2 patients were blastic NK cell lymphoma. From the basic analysis, 47% of the patients had stage I disease, 42% were stage II, 11% were stage III or IV. B-symptoms were present in 39%. 73% of these patients had International Prognostic Index (IPI) 0 or 1. Before treatment, 25% complicated with anemia. As to the therapy, 38% received chemotherapy alone, 3% received radiotherapy alone and 59% received a multidisciplinary therapy. After initial therapy, 59% achieved CR, 22% achieved PR and 19% were refractory disease. With a median follow-up duration of 20 months, the median overall survival was 28 months (95% CI: 10, 45). Hb lower than 110 g/l before treatment was statistically significant in multivariate analysis (p = 0.031). Presenting B-symptoms and ECOG PS score higher than 1 were also independent prognostic factors (P = 0.001 and 0.006 respectively). Conclusions: The outcome of patients with NK cell lymphoma was poor even for Stage I or II cases. Our data suggested Hemoglobin < 110 g/l had more prognostic value than IPI and Ann Arbor staging system for NK cell lymphoma in southern China, but it needs further confirmation. No significant financial relationships to disclose.

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Post-Whipple imaging in patients with pancreatic ductal adenocarcinoma: association with overall survival: a multivariate analysis

Abdominal Radiology ◽

10.1007/s00261-017-1099-2 ◽

2017 ◽

Vol 42 (8) ◽

pp. 2101-2107 ◽

Cited By ~ 6

Author(s):

Azadeh Elmi ◽

Janet Murphy ◽

Sandeep Hedgire ◽

Shaunagh McDermott ◽

Seyed-Mahdi Abtahi ◽

...

Keyword(s):

Overall Survival ◽

Multivariate Analysis ◽

Pancreatic Ductal Adenocarcinoma ◽

Ductal Adenocarcinoma

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Clinical Benefits of Conversion Surgery for Unresectable Pancreatic Ductal Adenocarcinoma: A Single-Institution, Retrospective Analysis

Cancers ◽

10.3390/cancers13051057 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1057

Author(s):

Yuko Mataki ◽

Hiroshi Kurahara ◽

Tetsuya Idichi ◽

Kiyonori Tanoue ◽

Yuto Hozaka ◽

...

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Pancreatic Ductal Adenocarcinoma ◽

Multidisciplinary Treatment ◽

Locally Advanced ◽

Advanced Pancreatic Cancer ◽

Ductal Adenocarcinoma ◽

Conversion Surgery ◽

Clinical Benefits ◽

Resectable Cancer

Background: Unresectable pancreatic ductal adenocarcinoma (UR-PDAC) has a poor prognosis. Conversion surgery is considered a promising strategy for improving the prognosis of UR-PDAC. This study aimed to investigate the clinical benefits of conversion surgery in patients with UR-PDAC. Methods: We retrospectively evaluated patients with PDAC who were referred to our department for possible surgical resection between January 2006 and December 2019. Conversion surgery was performed only in patients with UR-PDAC who could expect R0 resection. We analyzed the prognostic factors for overall survival among patients who underwent conversion surgery. Results: Overall, 638 patients with advanced pancreatic cancer were enrolled in this study. According to resectability, resectable cancer (R) was present in 180 patients, borderline resectable cancer (BR) was present in 60 patients, unresectable locally advanced cancer (UR-LA) was present in 252 patients, and unresectable cancer with distant metastasis (UR-M) was present in 146 patients. Conversion surgery was performed in 20 of the 398 UR cases (5.1%). The median period between the initial therapy and conversion surgery was 15.5 months. According to the Response Evaluation Criteria in Solid Tumors (RECIST) evaluation, the treatment response was CR in one patient, PR in 13, SD in five, and PD in one. Downstaging was pathologically determined in all cases. According to the Evans grading system, grade I was observed in four patients (20%), grade IIb was observed in seven (35%), III was observed in seven (35%), and IV was observed in two (10%). We compared the overall survival period from initial treatment among patients undergoing conversion surgery; the median overall survival durations in the conversion surgery, R, BR, UR-LA, and UR-M groups were 73.7, 32.7, 22.7, 15.7, and 8.8 months, respectively. Multivariate analysis revealed that the presence or absence of chemoradiotherapy (CRT) and the RECIST partial response (PR)/complete response (CR) for the main tumor were statistically significant prognostic factors for overall survival among patients undergoing conversion surgery (p = 0.004 and 0.03, respectively). Conclusion: In UR-PDAC, it is important to perform multidisciplinary treatment, including CRT with conversion surgery.

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Clinical Features and Outcomes Differ between Skeletal and Extraskeletal Osteosarcoma

Sarcoma ◽

10.1155/2014/902620 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 18

Author(s):

Sheila Thampi ◽

Katherine K. Matthay ◽

W. John Boscardin ◽

Robert Goldsby ◽

Steven G. DuBois

Keyword(s):

Overall Survival ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Clinical Features ◽

Older Patients ◽

High Grade ◽

Tumor Site ◽

Extraskeletal Osteosarcoma ◽

Tissue Of Origin ◽

High Grade Osteosarcoma

Background. Extraskeletal osteosarcoma (ESOS) is a rare subtype of osteosarcoma. We investigated patient characteristics, overall survival, and prognostic factors in ESOS.Methods. We identified cases of high-grade osteosarcoma with known tissue of origin in the Surveillance, Epidemiology, and End Results database from 1973 to 2009. Demographics were compared using univariate tests. Overall survival was compared with log-rank tests and multivariate analysis using Cox proportional hazards methods.Results. 256/4,173 (6%) patients with high-grade osteosarcoma had ESOS. Patients with ESOS were older, were more likely to have an axial tumor and regional lymph node involvement, and were female. Multivariate analysis showed ESOS to be favorable after controlling for stage, age, tumor site, gender, and year of diagnosis [hazard ratio 0.75 (95% CI 0.62 to 0.90);p=0.002]. There was an interaction between age and tissue of origin such that older patients with ESOS had superior outcomes compared to older patients with skeletal osteosarcoma. Adverse prognostic factors in ESOS included metastatic disease, larger tumor size, older age, and axial tumor site.Conclusion. Patients with ESOS have distinct clinical features but similar prognostic factors compared to skeletal osteosarcoma. Older patients with ESOS have superior outcomes compared to older patients with skeletal osteosarcoma.

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Pancreatic Ductal Adenocarcinoma at CT: A Combined Nomogram Model to Preoperatively Predict Cancer Stage and Survival Outcome

Frontiers in Oncology ◽

10.3389/fonc.2021.594510 ◽

2021 ◽

Vol 11 ◽

Author(s):

Chunyuan Cen ◽

Liying Liu ◽

Xin Li ◽

Ailan Wu ◽

Huan Liu ◽

...

Keyword(s):

Overall Survival ◽

Pancreatic Ductal Adenocarcinoma ◽

Clinical Characteristics ◽

Validation Cohort ◽

Stage I ◽

Ductal Adenocarcinoma ◽

Training Cohort ◽

Calibration Curves ◽

Kaplan Meier ◽

Radiomics Signature

ObjectivesTo construct a nomogram model that combines clinical characteristics and radiomics signatures to preoperatively discriminate pancreatic ductal adenocarcinoma (PDAC) in stage I-II and III-IV and predict overall survival.MethodsA total of 135 patients with histopathologically confirmed PDAC who underwent contrast-enhanced CT were included. A total of 384 radiomics features were extracted from arterial phase (AP) or portal venous phase (PVP) images. Four steps were used for feature selection, and multivariable logistic regression analysis were used to build radiomics signatures and combined nomogram model. Performance of the proposed model was assessed by using receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA). Kaplan-Meier analysis was applied to analyze overall survival in the stage I-II and III-IV PDAC groups.ResultsThe AP+PVP radiomics signature showed the best performance among the three radiomics signatures [training cohort: area under the curve (AUC) = 0.919; validation cohort: AUC = 0.831]. The combined nomogram model integrating AP+PVP radiomics signature with clinical characteristics (tumor location, carcinoembryonic antigen level, and tumor maximum diameter) demonstrated the best discrimination performance (training cohort: AUC = 0.940; validation cohort: AUC = 0.912). Calibration curves and DCA verified the clinical usefulness of the combined nomogram model. Kaplan-Meier analysis showed that overall survival of patients in the predicted stage I-II PDAC group was longer than patients in stage III-IV PDAC group (p<0.0001).ConclusionsWe propose a combined model with excellent performance for the preoperative, individualized, noninvasive discrimination of stage I-II and III-IV PDAC and prediction of overall survival.

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Extranodal NHL- A retrospective review of clinico-pathologic features and outcome and comparison with nodal NHL. Single institution experience years: 1988–2004

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.17542 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 17542-17542

Author(s):

A. Lal ◽

S. Adil ◽

N. Masood

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Early Stage ◽

Univariate Analysis ◽

International Prognostic Index ◽

Prognostic Index ◽

Primary Site ◽

Stage I ◽

Pathologic Features ◽

Significant Difference

17542 Background: Non-Hodgkin’s lymphoma (NHL) arising in an extra nodal (EN) site is not uncommon and its natural history and treatment is clearly characterized in the literature. Data on EN-NHL and comparison with N-NHL with relation to survival and prognostic factors is scarce in our part of the world. The primary objective of this study was to analyze the anatomic distribution, clinical features and outcome of DLBCL patients according to the primary site with applicability of International Prognostic Index (IPI). Methods: From 1988 to 2004, 557 patients were analyzed for the clinico-pathologic characteristics, treatment outcome and prognostic factors affecting overall survival. Results: Median age was 48.7 ± 15.3 years ; the M: F ratio was 2:1. The distribution according to the primary site was: lymph node, 322 cases (58%) of these 145 cases (44%) stage IV, 76 cases (23%) Stage III, 60 cases (18%) stage II and 47 cases(15%) stage I ; and EN sites, 235 (42%), including GIT (44%) followed by upper aerodigestive tract (19%), bones (08%), spine (05%), and 3% each as breast, CNS, testis,lungs. The median survival rate was 4.8 and 6.3 years in NL and ENL respectively vary according to primary site/stage of the lymphoma. In the univariate analysis age less than 60 years, early stage I-II, extra nodal involvement primarily gastric or bone, 0–1 extra nodal site, 0–1 PS, lack of B symptoms, normal LDH level has been associated with good prognosis. In the multivariate analysis age, PS, stage and level of LDH were the main variables to predict OS; no nodal or extranodal site maintained their prognostic value. Conclusion: Our data correspond with series from west increasing incidence extranodal lymphoma due to improved diagnostic techniques and superior results with chemotherapy by preserving the organ. Few patients with bowel obstruction or cord compression lymphoma required surgery for diagnosis or relief of symptoms. There is significant difference from western data in histologies DLBC-NHL is the most common histologies in our study. Overall survival patients with EN-NHL were similar to nodal NH-Lymphoma but largely depended on IPI. No significant financial relationships to disclose.

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Extranodal-NHL: Outcomeand Comparison with Nodal NHL. Single Institution Experience Year: 1988–2004.

Blood ◽

10.1182/blood.v108.11.4755.4755 ◽

2006 ◽

Vol 108 (11) ◽

pp. 4755-4755

Author(s):

Amar Lal ◽

Nehal Masood ◽

Salman Adil

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Early Stage ◽

Univariate Analysis ◽

International Prognostic Index ◽

Prognostic Index ◽

B Cell Lymphoma ◽

Primary Site ◽

Stage I ◽

Significant Difference

Abstract Background & Objective: Non-Hodgkin’s lymphoma (NHL) arising in an extra nodal (EN) site is not uncommon and its natural history and treatment is clearly characterized in the literature. Data on EN-NHL and comparison with N-NHL with relation to survival and prognostic factors is scarce in our part of the world. The primary objective of this study was to analyze the anatomic distribution, clinical features and outcome of Diffuse large B-cell lymphoma (DLBCL) patients according to the primary site (extra nodal vs nodal) with applicability of International Prognostic Index (IPI). Methods: From 1988 to 2004, 711 cases of NHL were diagnosed at our Institute. Out of these 145 (20%) patients were excluded as they were other than DLBCL hitopathology. Five hundreds fifty-seven (80%) patients were analyzed for the clinico-pathologic characteristics, treatment outcome and prognostic factors affecting overall survival. Ann Arbor staging system was used for staging with bone marrow biopsy, chest and abdominal radiography/CT. Results: Median age was 48.7 ± 15.3 years; the M: F ratio was 2:1. The distribution according to the primary site was: lymph node, 322 cases (58%) of these 145 cases (44%) stage IV, 76 cases (23%) Stage III, 60 cases (18%) stage II and 47 cases(15%) stage I; and EN sites, 235 (42%), including gastro-intestinal tract (44%) followed by upper aerodigestive tract (19%), bones (08%), spine (05%), and unusual sites less than 3% each as breast, CNS, testis, lungs and skin. The median survival rate was 4.8 and 6.3 years in NL and ENL respectively vary according to primary site/stage of the lymphoma. In the univariate analysis age less than 60 years, early stage I -II, extra nodal involvement primarily gastric or bone, 0–1 extra nodal site, 0–1 PS, lack of B symptoms, normal LDH level has been associated with good prognosis. In the multivariate analysis age, PS, stage and level of LDH were the main variables to predict OS; no nodal or extranodal site maintained their prognostic value. Conclusion: Our data correspond with series from west increasing incidence extranodal lymphoma due to improved diagnostic techniques and superior results with chemotherapy by preserving the organ. Few patients with bowel obstruction or cord compression lymphoma required surgery for diagnosis or relief of symptoms. There is significant difference from western data in histologies DLBC-NHL is the most common histologies in our study. Overall survival patients with EN-NHL were similar to nodal NH-Lymphoma but largely depended on IPI.

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Prognostic factors following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

International Surgery Journal ◽

10.18203/2349-2902.isj20185011 ◽

2018 ◽

Vol 5 (12) ◽

pp. 3877 ◽

Cited By ~ 2

Author(s):

Hazem M. Zakaria ◽

Anwar Mohamed ◽

Ayman Alsebaey ◽

Hazem Omar ◽

Dina ELazab ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Pancreatic Ductal Adenocarcinoma ◽

Tumor Size ◽

Ductal Adenocarcinoma ◽

Tumor Diameter ◽

Advanced Tumor Stage ◽

Poorly Differentiated ◽

Risk Factors For Survival

Background: Pancreatic ductal adenocarcinoma (PDAC) had a poor prognosis and surgical resection remains the only potentially curative treatment. The aim of the study was to identify the outcome and risk factors affecting survival after pancreaticoduodenectomy (PD) for PDAC.Methods: The patients who underwent PD for PDAC from 2007 to 2015 were retrospectively studied. Cox regression test for multivariate analysis was used for evaluation of prognostic factors for survival.Results: Ninety-four patients underwent PD for PDAC, 20 patients (21.3%) had major postoperative complications. The perioperative mortality was 4.3%. The 1-, 3-, and 5-years survival rates were 74.5%, 38.7%, 23.4, respectively. In univariate analysis the risk factors for survival were; presence of co-morbidity (P=0.03), high preoperative carbohydrate antigen (CA)19-9 > 400U/ml (P=0.02), advanced tumor stage (P=0.03), large tumor diameter >3cm (P=0.01), poorly differentiated tumor (P= 0.02), involved resection margin (P=0.04), and positive lymph nodes in pathology after surgery (P=0.03). In multivariate analysis the independent risk factors for survival were; high preoperative CA 19-9 (P=0.042), tumor size >3cm (P=0.038), poorly differentiated tumor in histopathology (P=0.045).Conclusions: High tumor marker CA19-9, tumor size, and grade are significant risk factors for poor survival after resection of PDAC and should be taken into account in the selection of patients for surgery to improve the outcome.

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Clinical Benefits of Conversion Surgery for Unresectable Pancreatic Ductal Adenocarcinoma: A Single-Institution, Retrospective Analysis

10.20944/preprints202102.0085.v1 ◽

2021 ◽

Author(s):

Yuko Mataki ◽

Hiroshi Kurahara ◽

Tetsuya Idichi ◽

Kiyonori Tanoue ◽

Yuto Hozaka ◽

...

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Pancreatic Ductal Adenocarcinoma ◽

Multidisciplinary Treatment ◽

Locally Advanced ◽

Advanced Pancreatic Cancer ◽

Ductal Adenocarcinoma ◽

Conversion Surgery ◽

Clinical Benefits ◽

Resectable Cancer

BackgroundUnresectable pancreatic ductal adenocarcinoma (UR-PDAC) has a poor prognosis. Conversion surgery is considered a promising strategy for improving the prognosis of UR-PDAC. This study aimed to investigate the clinical benefits of conversion surgery in patients with UR-PDAC.Methods: We retrospectively evaluated patients with PDAC who were referred to our department for possible surgical resection between January 2006 and December 2019. Conversion surgery was performed only in patients with UR-PDAC who could expect R0 resection. We analyzed the prognostic factors for overall survival among patients who underwent conversion surgery. Results: Overall, 638 patients with advanced pancreatic cancer were enrolled in this study. According to resectability, resectable cancer (R) was present in 180 patients, borderline resectable cancer (BR) in 60, unresectable locally advanced cancer (UR-LA) in 252, and unresectable cancer with distant metastasis (UR-M) in 146. Conversion surgery was performed in 20 of the 398 UR cases (5.1%). The median period between the initial therapy and conversion surgery was 15.5 months. According to the RECIST evaluation, the treatment response was CR in one patient, PR in 13, SD in five, and PD in one. Downstaging was pathologically determined in all cases. According to the Evans grading system, grade I was observed in four patients (20%), grade IIb in seven (35%), III in seven (35%), and IV in two (10%). We compared the overall survival period from initial treatment among patients undergoing conversion surgery; the median overall survival durations in the conversion surgery, R, BR, UR-LA, and UR-M groups were 73.7, 32.7, 22.7, 15.7, and 8.8 months, respectively. Multivariate analysis revealed that the presence or absence of CRT and the RECIST PR/CR for the main tumor were statistically significant prognostic factors for overall survival among patients undergoing conversion surgery (p = 0.004 and 0.03, respectively).Conclusion: In UR-PDAC, it is important to perform multidisciplinary treatment, including CRT with conversion surgery.

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