scholarly journals The Role of Location of Tumor in the Prognosis of the Pancreatic Cancer

Cancers ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2036
Author(s):  
Mirang Lee ◽  
Wooil Kwon ◽  
Hongbeom Kim ◽  
Yoonhyeong Byun ◽  
Youngmin Han ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Multivariate Analysis ◽  
Survival Rate ◽  
Prognostic Factor ◽  
Locally Advanced ◽  
Pancreatic Head ◽  
The Body ◽  
Significant Prognostic Factor ◽  
Clinicopathologic Characteristics ◽  
Curative Intent

Identification of prognostic factors is important to improve treatment outcomes in pancreatic cancer. This study aimed to investigate the effect of the location of pancreatic cancer on survival and to determine whether it was a significant prognostic factor. Altogether, 2483 patients diagnosed with pancreatic cancer were examined. Comparative analysis of clinicopathologic characteristics, survival analysis, and multivariate analysis were performed. Cancers of the pancreatic head or the uncinate process were present in 49.5% of patients. The head/uncinate cancers had more clinical T1/T2 tumors (59.4% vs. 35.5%, p < 0.001) and a significantly higher 5-year survival rate (8.9% vs. 7.3%, p < 0.001) than the body/tail cancers. The 5-year survival rate in patients with head/uncinate cancers was significantly lower in the resectable (p = 0.014) and the locally advanced groups (p = 0.007). In patients who underwent resection with curative intent, the 5-year survival rate was lower in the head/uncinate group (p = 0.046). The overall outcome of the head/uncinate cancers was better than the body/tail cancers, due to the high proportion of resectable cases. In patients who underwent curative resection, the head/uncinate cancers had a higher number of T1/T2 tumors, but worse outcomes. In the multivariate analysis, tumor location was not an independent prognostic factor for pancreatic cancer.

scholarly journals Symptom Relief is the Most Significant Prognostic Factor for Unresectable Locally Advanced/Recurrent Pancreatic Cancer Receiving Chemoradiotherapy: Analysis of 65 Cases

2020 ◽  
Author(s):  
Ting Jiang ◽  
Jingxian Shen ◽  
Shuang Liu ◽  
Qing Liu ◽  
Weiwei Xiao ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Prognostic Factor ◽  
Radiation Dose ◽  
Cox Regression ◽  
Symptom Relief ◽  
Locally Advanced ◽  
Rank Test ◽  
Significant Prognostic Factor ◽  
Cox Regression Analysis ◽  
Recurrent Pancreatic Cancer

Abstract BackgroundPancreatic cancer is the fourth leading cause of cancer-related death throughout the world. For local advanced and recurrent pancreatic cancer (LAPC/LRPC), chemoradiotherapy (CRT) is a main choice which may prolong their survival and ease patients’ symptoms.MethodsWe constructed a database of 65 patients with LAPC/LRPC treated from June, 2004 to February, 2018. We used log-rank test to evaluate the different overall survival (OS) rates of all factors involved, and used cox regression model to find out independent prognostic factors for these patients.ResultsThe median OS time for 65 eligible patients was 23.6 months. 47 (72.3%) and 18 (27.7%) patients had unresectable LAPC and LRPC, and median OS time was 17.2 and 40.7 months (P= 0.02), respectively. The mean biological effective dose (BED) to gross tumor volume (GTV) was 64.8Gy (46.7-85.5 Gy). 11(16.9%) and 54(83.1%) patients had BED> 72 Gy and BED≤ 72 Gy, and their mOS was 31.8 and 21.9 months (P= 0.08), respectively. Simultaneous dose boost to interval GTV (GTVin) was applied to 23 patients (35.4%). Patients with large GTV volume (≥ 109.2 cm3) may benefit from radiation dose boost (mOS: 27.6 vs. 5.3 months, P= 0.004). Patients with symptom relief including relief of pain, jaundice, and/or diarrhea had higher OS rates than those without response (mOS: 25.7 vs. 13.2 months, P< 0.01) and multivariate cox regression analysis suggested symptom relief was the most significant prognostic factor for OS (HR= 0.44, 95%CI 0.35-2.36, P= 0.02).ConclusionCRT with simultaneous integrated boost of radiation dose may bring survival benefit for LAPC/LRPC patients with bulk tumor. Symptom relief is the most significant prognostic factor for LAPC/LRPC patients after comprehensive CRT.

The referential survival data of borderline resectable pancreatic cancer (BRPC) patients who are candidate for neoajuvant chemotherapy followed by surgery.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 434-434
Author(s):  
Kei Saito ◽  
Hiroshi Ishii ◽  
Masato Ozaka ◽  
Hiroki Osumi ◽  
Ikuhiro Yamada ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Survival Rate ◽  
Survival Data ◽  
Median Survival Time ◽  
Selection Criteria ◽  
Locally Advanced ◽  
Occult Metastasis ◽  
Curative Intent ◽  
Group A ◽  
Group B

434 Background: The aim of this study is to clarify referential survival data of BRPC patients who are candidate for neoajuvant chemotherapy followed by surgery. Methods: This retrospective study included data from all consecutive patients who were diagnosed as having invasive ductal pancreatic cancer at our hospital between January 2008 and December 2013. Selection criteria were as follows: patients who 1) had histologically confirmed pancreatic adenocarcinoma, 2) were diagnosed as having non-metastatic disease by dynamic CT before treatment, 3) had received anti-cancer treatment, and had been observed for 3 months or longer. We reviewed CT stage (UICC) and treatment modality, and analyzed their survival data. Results: There were 428 patients who met the selection criteria. Among them, clinical CT stage I/II (Group A; potentially respectable) and stage III (Group B; locally advanced) were documented in 170 (40%) and 131, respectively. Laparotomy was performed in all patients in Group A. Of the 170 in Group A, 166 (98%) received resection with curative intent, and the remaining 4 did not received resection because of discovery of occult metastasis at laparotomy. Of the 131 in Group B, 36 (27%; Group B-1) received resection with curative intent, 7 did not received resection because of occult metastasis, and the remaining 88 did not receive laparotomy because they were diagnosed as having locally advanced unresectable disease by CT. Among Group B, patients other than Group B-1 received gemcitabine-based chemotherapy (Group B-2; N=95). The median survival time, 1-yr, 2-yr, and 3-yr survival rate were 28.7 months, 78.6%, 55.5%, and 38.9% in Group A, 16.8 months, 63.8%, 31.8%, and 19.8% in Group B-1, and 13.8 months, 60.1%, 21.7%, and 5.9% in Group B-2, respectively. Conclusions: Based on our historical data, we suppose that 16.8 months of median survival time or survival rate of 19.8 at 3-yr, i.e, Group B-1 survival data, may be an appropriate threshold value in the single-arm phase 2 BRPC study.

scholarly journals Sarcopenia as a Prognostic Factor of Hepatotoxicity and Lower Survival Rate in Chemotherapy of Pancreatic Cancer

2020 ◽  
Vol 30 (3) ◽  
pp. 49-54
Author(s):  
A. A. Klunichenko ◽  
A. P. Seryakov ◽  
A. A. Seryakova ◽  
S. M. Demidov
Keyword(s):  
Skeletal Muscle ◽  
Pancreatic Cancer ◽  
Survival Rate ◽  
Prognostic Factor ◽  
Locally Advanced ◽  
Metastatic Pancreatic Cancer ◽  
Skeletal Muscle Index ◽  
Lower Survival Rate ◽  
Lower Survival ◽  
Total Survival

Aim. Evaluation of sarcopenia’s effect on hepatotoxicity in patients with locally advanced and metastatic pancreatic cancer (PC).Materials and methods. A retro-prospective study included 66 patients (30 men and 36 women) with locally advanced and metastatic PC receiving chemotherapy treatment in the form of gemcitabine monotherapy and in combination with platinum, taxanes, fluoropyrimidines in standard chemotherapy protocols. Sarcopenia was observed using computer tomography with intravenous bolus contrast and nonionic contrast medium with iodine concentration 350 mg/ml. Muscle tissue area (cm2) was estimated with two consecutive axial slices at the level of L3 lumbar vertebra. Sarcopenia was determined with the L3 skeletal muscle index (L3SMI) calculated as a ratio of skeletal muscle area at the L3 vertebra to patient’s height squared. Condition was marked as sarcopenia at L3SMI values of 52.4 cm2/m2 in men and 38.5 cm2/m2 in women.Results. Hepatotoxicity was revealed in 57.5% (n = 38) of PC patients receiving chemotherapy, with 60.87% (n = 28) of them having sarcopenia. In patients with sarcopenia and no toxic effects, the total survival median was 41 months, whilst hepatotoxicity combined with sarcopenia was associated with almost a 3 times lower median survival (14.1 months). A better survival trend was observed in a polychemotherapy cohort without sarcopenia, with the total survival median of 17.0 months compared to 15.2 months in such patients with sarcopenia (p = 0.781). A positive trend towards survival was observed in a hepatotoxicity-negative cohort, with the total survival median of 18.7 months compared to 16.9 months in PC patients with toxic side effects (p = 0.174).Conclusions. Sarcopenia may be used as a prognostic factor of lower survival rate and higher hepatotoxic effect of chemotherapy in patients with locally advanced and metastatic pancreatic cancer.

scholarly journals Combined resection of the hepatic artery without reconstruction in pancreaticoduodenectomy: a case report of pancreatic cancer with an aberrant hepatic artery

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Tadao Kuribara ◽  
Tatsuo Ichikawa ◽  
Kiyoshi Osa ◽  
Takeshi Inoue ◽  
Satoshi Ono ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Hepatic Artery ◽  
Locally Advanced ◽  
Pancreatic Head ◽  
Arterial Embolization ◽  
Arterial Blood Flow ◽  
Temporary Increase ◽  
Combined Resection ◽  
Arterial Blood ◽  
Arterial Resection

Abstract Background Pancreaticoduodenectomy (PD) is rarely performed for pancreatic cancer with hepatic arterial invasion owing to its poor prognosis and high surgical risks. Although there has been a recent increase in the reports of PD combined with hepatic arterial resection due to improvements in disease prognosis and operative safety, PD with major arterial resection and reconstruction is still considered a challenging treatment. Case presentation A 61-year-old man with back pain was diagnosed with pancreatic head and body cancer. Although distant metastasis was not confirmed, the tumor had extensively invaded the hepatic artery; therefore, we diagnosed the patient with locally advanced unresectable pancreatic cancer. After gemcitabine plus nab-paclitaxel (GnP) therapy, the tumor considerably decreased in size from 35 to 20 mm. Magnetic resonance imaging revealed a gap between the tumor and the hepatic artery. Tumor marker levels returned to their normal range, and we decided to perform conversion surgery. In this case, an artery of liver segment 2 (A2) had branched from the left gastric artery; therefore, we decided to preserve A2 and perform PD combined with hepatic arterial resection without reconstruction. After four cycles of GnP therapy, we performed hepatic arterial embolization to prevent postoperative ischemic complications prior to surgery. Immediately after embolization, collateral arterial blood flow to the liver was observed. Operation was performed 19 days after embolization. Although there was a temporary increase in liver enzyme levels and an ischemic region was found near the surface of segment 8 of the liver after surgery, no liver abscess developed. The postoperative course was uneventful, and S-1 was administered for a year as adjuvant chemotherapy. The patient is currently alive without any ischemic liver events and cholangitis and has not experienced recurrence in the past 4 years since the surgery. Conclusions In PD for pancreatic cancer with hepatic arterial invasion, if a part of the hepatic artery is aberrant and can be preserved, combined resection of the common and proper hepatic artery without reconstruction might be feasible for both curability and safety.

Maintenance of Skeletal Muscle Mass During FOLFIRINOX is a Favorable Prognostic Factor in Pancreatic Cancer Patients

2021 ◽  
Author(s):  
Dong Woo Shin ◽  
Minseok Albert Kim ◽  
Jong-chan Lee ◽  
Jaihwan Kim ◽  
Jin-Hyeok Hwang
Keyword(s):  
Skeletal Muscle ◽  
Pancreatic Cancer ◽  
Prognostic Factor ◽  
Clinical Outcomes ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Lumbar Vertebra ◽  
Resection Rate ◽  
Cross Sectional ◽  
Group 2

Abstract Objective: The study aimed to investigate the effect of body composition changes during chemotherapy on clinical outcomes in patients with pancreatic cancer.Results: In patients with locally advanced pancreatic cancer (LAPC), the cross-sectional area of skeletal muscle (SM) and adipose tissue (AT) at the level of third lumbar vertebra was measured. The SM and AT ratios indicated the changes during chemotherapy. The patients were classified into three groups based on these ratios: group 1, ≥1.00; group 2, 0.85-0.99; group 3, <0.85. The overall survival (OS) and surgical resection rates were estimated. Fifty-eight patients with LAPC who received first-line FOLFIRINOX were analysed. Fifteen (25.9%) patients who underwent resection showed maintained BMI, SM, and AT as compared to the patients who did not undergo resection. As the SM ratio decreased, the risk for death increased significantly. Further, the resection rate was significantly higher in patients with maintained SM compared to those with low SM ratio. On the contrary, the change in AT ratio was not associated with OS and resection rate; however, significant decrease in AT more than 15% showed poor clinical outcomes. Maintenance of SM during chemotherapy is a reliable prognostic factor indicating longer OS and higher resection rate.

Prognostic impact of chemoradiation-related lymphopenia in patients with locally advanced pancreatic cancer.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 439-439
Author(s):  
Daniel W Kim ◽  
Grace Lee ◽  
Colin D. Weekes ◽  
David P. Ryan ◽  
Aparna Raj Parikh ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cox Model ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Pancreatic Head ◽  
Locally Advanced Pancreatic Cancer ◽  
Ductal Adenocarcinoma ◽  
Prognostic Impact ◽  
Entire Cohort ◽  
Grade 3

439 Background: Chemoradiation (CRT) induced lymphopenia is common and associated with poorer survival in multiple solid malignancies. The objective of this study was to evaluate the prognostic impact of lymphopenia in patients with nonmetastatic, unresectable pancreatic ductal adenocarcinoma (PDAC) treated by neoadjuvant FOLFIRINOX (5-fluorouracil [5FU]/leucovorin/irinotecan/oxaliplatin) followed by CRT. We hypothesized that severe lymphopenia would correlate with worse survival. Methods: The inclusion criteria for this single-institution retrospective study were: 1) biopsy-proven diagnosis of unresectable PDAC, 2) absence of distant metastasis, 3) receipt of neoadjuvant FOLFIRINOX followed by CRT, and 4) absolute lymphocyte count (ALC) available prior to and two months after initiating CRT. In general, CRT consisted of 5FU or capecitabine and RT with 58.8 Gy over 28 fractions. Lymphopenia was graded according to CTCAE v5.0. The primary variable of interest was lymphopenia at two months, dichotomized by ALC of < 0.5/μl (Grade 3 lymphopenia). The primary endpoint was overall survival (OS). Cox modeling and Kaplan-Meier methods were used to perform survival analyses. Results: A total of 138 patients were identified. Median follow-up for the entire cohort was 16 months. Median age was 65. Fifty-six percent were female, 86% were Caucasian, and 97% had ECOG ≤1. Median tumor size was 3.8 cm. Tumor location was pancreatic head in 63%, body in 22%, tail in 8%, and neck in 7%. Median baseline ALC for the entire cohort was 1.5 k/ul. Two months after initiating CRT, 106 (77%) had severe (Grade 3 or worse) lymphopenia. While there were no significant differences in baseline patient or disease characteristics, patients with severe lymphopenia received higher doses of RT with longer duration of treatment compared to those without severe lymphopenia. On multivariable Cox model, severe lymphopenia at two months was significantly associated with increased hazards of death (HR = 4.00 [95% CI 2.03-7.89], p < 0.001). Greater number of neoadjuvant FOLFIRINOX cycles received prior to CRT was associated with lower hazards of death (HR = 0.84 [95% CI 0.77-0.92], p < 0.001). The 12-month OS was 73% vs. 90% in the cohort with vs. without severe lymphopenia, respectively (log-rank p < 0.001). Conclusions: Treatment-related lymphopenia is common and severe lymphopenia may be a prognostic marker of poorer survival in locally advanced pancreatic cancer. Closer observation in high-risk patients and minimization of RT dose and duration are potential approaches to mitigating CRT-related lymphopenia. Our findings also suggest an important role of the host immunity in pancreatic cancer outcomes, supporting the ongoing efforts of immunotherapy trials in pancreatic cancer.

scholarly journals Omics Approaches in Pancreatic Adenocarcinoma

Cancers ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 1052
Author(s):  
Iranzu González-Boja ◽  
Antonio Viúdez ◽  
Saioa Goñi ◽  
Enrique Santamaria ◽  
Estefania Carrasco-García ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Survival Rate ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Ductal Adenocarcinoma ◽  
Curative Intent ◽  
Pancreatic Cancers ◽  
Wide Range ◽  
Prevention And Treatment ◽  
Shed Light

Pancreatic ductal adenocarcinoma, which represents 80% of pancreatic cancers, is mainly diagnosed when treatment with curative intent is not possible. Consequently, the overall five-year survival rate is extremely dismal—around 5% to 7%. In addition, pancreatic cancer is expected to become the second leading cause of cancer-related death by 2030. Therefore, advances in screening, prevention and treatment are urgently needed. Fortunately, a wide range of approaches could help shed light in this area. Beyond the use of cytological or histological samples focusing in diagnosis, a plethora of new approaches are currently being used for a deeper characterization of pancreatic ductal adenocarcinoma, including genetic, epigenetic, and/or proteo-transcriptomic techniques. Accordingly, the development of new analytical technologies using body fluids (blood, bile, urine, etc.) to analyze tumor derived molecules has become a priority in pancreatic ductal adenocarcinoma due to the hard accessibility to tumor samples. These types of technologies will lead us to improve the outcome of pancreatic ductal adenocarcinoma patients.

scholarly journals Locally Advanced Pancreatic Head Cancer: Margin-Positive Resection or Bypass?

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Ulrich Friedrich Wellner ◽  
Frank Makowiec ◽  
Dirk Bausch ◽  
Jens Höppner ◽  
Olivia Sick ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Locally Advanced ◽  
Pancreatic Head ◽  
Resection Margins ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome ◽  
Pancreatic Head Cancer ◽  
Margin Positive

Pancreatic cancer is a highly aggressive disease with poor survival. The only effective therapy offering long-term survival is complete surgical resection. In the setting of nonmetastatic disease, locally advanced tumors constitute a technical challenge to the surgeon and may result in margin-positive resection margins. Few studies have evaluated the implications of the latter in depth. The aim of this study was to compare the margin-positive situation to palliative bypass procedures and margin-negative resections in terms of perioperative and long-term outcome. By retrospective analysis of prospectively maintained data from 360 patients operated for pancreatic cancer at our institution, we provide evidence that margin-positive resection still yields a significant survival benefit over palliative bypass procedures. At the same time, perioperative severe morbidity and mortality are not significantly increased. Our observations suggest that pancreatic cancer should be resected whenever technically feasible, including, cases of locally advanced disease.

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