Neoadjuvant radiation followed by resection versus upfront resection for locally advanced pancreatic cancer patients: a propensity score matched analysis

326 Background: It is well known that locally advanced pancreatic cancer patients have a poor prognosis. Recently, hematologic markers showing systemic inflammatory status such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have aroused much attention due to its potential to predict patient survival. In this study, we investigated whether pre-treatment NLR and PLR independently and in combination would be significant prognostic factors for survival in locally advanced pancreatic cancer patients. Methods: A total of 497 locally advanced (borderline resectable and unresectable) pancreatic cancer patients who received neoadjuvant or definitive chemoradiotherapy (CCRT) between January 2005 and December 2015 were included in this study. NLR and PLR prior to the start of treatment within 2 weeks were defined as pre-treatment NLR and PLR. We divided the patients with the median values of pre-treatment NLR and PLR; NLR < 2.44 group (n = 248), NLR ≥ 2.44 group (n = 249), PLR < 149 group (n = 248) and PLR ≥ 149 (n = 249) group. Overall survival (OS) and progression-free survival (PFS) were compared between each group for NLR and PLR. Results: Median overall survival was 15.7 months (range, 2.3-128.5 months). For NLR, the OS, PFS rates were significantly lower in the NLR ≥ 2.44 group, with 1-year OS rates of 67.9% and 61.5% (p = 0.003) and 1-year PFS rates of 38.1% and 32.4% (p = 0.003), for NLR < 2.44 and ≥ 2.44 group, respectively. The PLR ≥ 149 group also showed significantly poorer OS and PFS than PLR < 149 group. The 1-year OS rates were 68.1% and 61.3% (p = 0.029) and 1-year PFS rates were 37.9% and 32.5% (p = 0.027), for PLR < 149 and ≥ 149 group, respectively. When multivariate analysis was performed, NLR ≥ 2.44 remained as a significant adverse factor for OS (p = 0.011) and PFS (p = 0.026). PLR > 149 also proved to be a significant factor for poorer OS (p = 0.003) and PFS (p = 0.021). Conclusions: Elevated pre-treatment NLR and PLR independently and in combination significantly predicted poor OS and PFS. Pre-treatment NLR and PLR are useful prognostic factors for OS and PFS in locally advanced pancreatic cancer patients.

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Effect of anti-CTGF human recombinant monoclonal antibody pamrevlumab on resectability and resection rate when combined with gemcitabine/nab-paclitaxel in phase 1/2 clinical study for the treatment of locally advanced pancreatic cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.15_suppl.4016 ◽

2018 ◽

Vol 36 (15_suppl) ◽

pp. 4016-4016 ◽

Cited By ~ 5

Author(s):

Vincent J. Picozzi ◽

Michael J. Pishvaian ◽

Kabir Mody ◽

Jordan Michael Winter ◽

John A. Glaspy ◽

...

Keyword(s):

Pancreatic Cancer ◽

Monoclonal Antibody ◽

Clinical Study ◽

Cancer Patients ◽

Phase 1 ◽

Locally Advanced ◽

Advanced Pancreatic Cancer ◽

Locally Advanced Pancreatic Cancer ◽

Resection Rate ◽

Recombinant Monoclonal Antibody

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Treatment of Locally Advanced Pancreatic Cancer in the Real World: Population-Based Practices and Effectiveness

Journal of Clinical Oncology ◽

10.1200/jco.2003.03.007 ◽

2003 ◽

Vol 21 (18) ◽

pp. 3409-3414 ◽

Cited By ~ 77

Author(s):

Monika K. Krzyzanowska ◽

Jane C. Weeks ◽

Craig C. Earle

Keyword(s):

Pancreatic Cancer ◽

Propensity Score ◽

Elderly Patients ◽

Cox Model ◽

Combined Modality Therapy ◽

Locally Advanced ◽

Advanced Pancreatic Cancer ◽

Locally Advanced Pancreatic Cancer ◽

World Population ◽

Propensity Score Methods

Purpose: To evaluate the use and effectiveness of cancer-directed therapy in elderly patients with locally advanced pancreatic cancer (LAPC). Methods: We used the linked Surveillance, Epidemiology, and End Results Medicare database to perform a retrospective cohort study in 1,696 patients diagnosed with LAPC between 1991 and 1996. We calculated cancer-directed treatment use rates, then used logistic regression to identify patient and health system factors that were associated with receipt of treatment. Effectiveness of treatment was estimated using Cox proportional hazards models and propensity score methods. Results: In our cohort, 44% of patients received some form of cancer-directed therapy (24% radiation with concurrent chemotherapy, 13% radiation alone, and 7% chemotherapy alone). Older age, lower socioeconomic status, presence of comorbid illness, no care in a teaching hospital, and residence in the western United States were associated with a lower likelihood of receiving treatment (P ≤ .05). Among those treated, younger age and certain geographic locations were the only predictors of receiving combined-modality therapy. The adjusted hazard ratio for death associated with any treatment in the Cox model was 0.53 (P < .0001). Effectiveness estimates obtained using propensity score methods were similar. Conclusion: This analysis supports the effectiveness of cancer-directed treatment in elderly patients with LAPC, but use is low. Receipt of treatment is strongly correlated with non–disease-related factors, especially sociodemographic characteristics, indicating possible disparities in access to care.

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Irreversible electroporation followed by chemotherapy vs. chemotherapy alone for locally advanced pancreatic cancer: A large cohort propensity score analysis.

Journal of Global Oncology ◽

10.1200/jgo.2019.5.suppl.117 ◽

2019 ◽

Vol 5 (suppl) ◽

pp. 117-117

Author(s):

Chaobin He ◽

Shengping Li

Keyword(s):

Pancreatic Cancer ◽

Propensity Score ◽

Combination Therapy ◽

Propensity Score Analysis ◽

Locally Advanced ◽

Irreversible Electroporation ◽

Advanced Pancreatic Cancer ◽

Locally Advanced Pancreatic Cancer ◽

Combination Method ◽

Local Progression

117 Background: Locally advanced pancreatic cancer (LAPC) has a dismal prognosis with the standard chemotherapy and the local progression contributed to nearly one-third of deaths of these patients. Irreversible electroporation (IRE) is a local destructive method which is feasible for the treatment of LAPC. The aim of this study was to evaluate IRE combined with chemotherapy as a new treatment and compared its efficacy with that of chemotherapy alone for LAPC patients. Methods: Data of LAPC patients who received chemotherapy combined IRE or not were extracted from database of the Surveillance, Epidemiology, and End Results (SEER) and Sun Yat-sen University Cancer Center (SYSUCC). The efficacy of these two treatments was compared based on data analyzed with propensity score matching (PSM) analysis. Results: In all, 3515 LAPC patients from SEER database were included, including 3348 patients received chemotherapy and 167 patients received combination therapy of IRE and chemotherapy. Additionally, 36 patients who received IRE plus chemotherapy and another 96 patients who received chemotherapy from the SYSUCC were included. After PSM, survival rates were compared between two groups. Patients in combination group achieved better survival than those in chemotherapy group [SEER: overall survival (OS), 16.0 months (95% CI, 12.0-21.0) vs 9.0 months (95% CI, 7.2-11.6), P < 0.001; SYSUCC: OS, 21.6 months (95% CI, 17.8-25.3) vs 7.1 months (95% CI, 5.4-9.5), P = 0.006]. Moreover, similar better results in terms of cancer-specific survival (CSS) and progression-free survival (PFS) were observed in patients who received combination therapy compared with chemotherapy alone. IRE combined with chemotherapy was shown as a favorable factor for OS, CSS and PFS in LAPC patients. Conclusions: Patients with LAPC who received IRE combined with chemotherapy had better survival compared with those after chemotherapy treatment alone. This combination method may be a more suitable way of treatment for patients with LAPC.

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