Meta-Analysis of Circulating Cell-Free DNA’s Role in the Prognosis of Pancreatic Cancer

Introduction: The analysis of cell-free DNA (cfDNA) for genetic abnormalities is a promising new approach for the diagnosis and prognosis of pancreatic cancer patients. Insights into the molecular characteristics of pancreatic cancer may provide valuable information, leading to its earlier detection and the development of targeted therapies. Material and Methods: We conducted a systematic review and a meta-analysis of studies that reported cfDNA in pancreatic ductal adenocarcinoma (PDAC). The studies were considered eligible if they included patients with PDAC, if they had blood tests for cfDNA/ctDNA, and if they analyzed the prognostic value of cfDNA/ctDNA for patients’ survival. The studies published before 22 October 2020 were identified through the PubMED, EMBASE, Web of Science and Cochrane Library databases. The assessed outcomes were the overall (OS) and progression-free survival (PFS), expressed as the log hazard ratio (HR) and standard error (SE). The summary of the HR effect size was estimated by pooling the individual trial results using the Review Manager, version 5.3, Cochrane Collaboration. The heterogeneity was assessed using the Cochran Q test and I2 statistic. Results: In total, 48 studies were included in the qualitative review, while 44 were assessed in the quantitative synthesis, with the total number of patients included being 3524. Overall negative impacts of cfDNA and KRAS mutations on OS and PFS in PDAC (HR = 2.42, 95% CI: 1.95–2.99 and HR = 2.46, 95% CI: 2.01–3.00, respectively) were found. The subgroup analysis of the locally advanced and metastatic disease presented similar results (HR = 2.51, 95% CI: 1.90–3.31). In the studies assessing the pre-treatment presence of KRAS, there was a moderate to high degree of heterogeneity (I2 = 87% and I2 = 48%, for OS and PFS, respectively), which was remarkably decreased in the analysis of the studies measuring post-treatment KRAS (I2 = 24% and I2 = 0%, for OS and PFS, respectively). The patients who were KRAS positive before but KRAS negative after treatment had a better prognosis than the persistently KRAS-positive patients (HR = 5.30, 95% CI: 1.02–27.63). Conclusion: The assessment of KRAS mutation by liquid biopsy can be considered as an additional tool for the estimation of the disease course and outcome in PDAC patients.

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Ultra-low Input Circulating Tumor DNA Detection by MED-Amp in Early-Stage Pancreatic Cancer

10.1101/2021.03.28.437388 ◽

2021 ◽

Author(s):

Erica D Pratt ◽

David B Zhen ◽

Robert W Cowan ◽

Heather Cameron ◽

Kara Schradle ◽

...

Keyword(s):

Early Stage ◽

Locally Advanced ◽

Progression Free Survival ◽

Circulating Tumor Dna ◽

Fold Change ◽

Diagnostic Sensitivity ◽

Ductal Adenocarcinoma ◽

Kras Mutations ◽

The Relationship ◽

Tumor Dna

Purpose: The clinical utility of circulating tumor DNA (ctDNA) has been shown in advanced pancreatic ductal adenocarcinoma (PDA). However, diagnostic sensitivity of many ctDNA assays is low in resectable and locally advanced disease, where tumor burden is substantially lower. We have previously described Multiplex Enrichment using Droplet Pre-Amplification (MED-Amp), a multiplexed panel for the detection of the most common oncogenic KRAS mutations in PDA. In this study, we aimed to assess the diagnostic sensitivity of MED-Amp for detection of rare mutant alleles present in the plasma of patients with localized PDA. Experimental Design: We retrospectively analyzed ninety-eight plasma samples from 51 patients with various stages of localized disease. For comparison, we measured ctDNA levels in 20 additional patients with metastatic PDA. The MED-Amp assay was used to measure the abundance of the four most common KRAS codon 12 mutations (G12C/D/R/V). We correlated the presence and quantity of ctDNA with overall survival (OS) as well as progression-free survival (PFS). Using serial plasma draws, we also assessed the relationship between changes in ctDNA allelic frequency and progression. Results: KRAS-positive ctDNA was detected in 52.9% of localized PDA and 75% of metastatic samples tested using DNA inputs as low as 2 ng. As previously reported, the presence of KRAS mutant ctDNA was correlated with worse OS for all disease stages (p = 0.02). In patients with localized PDA high ctDNA levels also correlated with significantly worse median OS (533 days vs 1090 days) and PFS (192 days vs 787 days). We also studied a small cohort of serial plasma draws to observe the relationship between ctDNA fold change and PFS. We found 83% of patients with increased fold change in mutant KRAS experienced disease progression (n=6). In contrast, 75% (n=4) of patients with decreased fold change remained disease-free (p=0.03). Conclusions: MED-Amp is a flexible and cost-effective approach for measurement of ctDNA in patients with localized cancer. Though this study focused on KRAS mutation detection, this assay could be adapted for a number of common oncogenic alterations.

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Efficacy and Safety of PEGPH20 in Pancreatic Cancer: A Systematic Review and Meta-Analysis

Current Cancer Therapy Reviews ◽

10.2174/1573394717666210616152341 ◽

2021 ◽

Vol 17 ◽

Author(s):

Vinod Solipuram ◽

Harish Gopalakrishna ◽

Gayatri Naira ◽

Akhila Mohan

Keyword(s):

Pancreatic Cancer ◽

Placebo Group ◽

Febrile Neutropenia ◽

Adverse Events ◽

Meta Analysis ◽

Progression Free Survival ◽

Cochrane Library ◽

Thromboembolic Events ◽

Serious Adverse Events ◽

Significant Difference

Introduction: Pancreatic cancer is an aggressive tumor that had an estimated 57,600 new cases and 47,050 deaths in 2020 in the US alone. Recent studies have targeted tumor microenvironment (TME) for better delivery of systemic chemotherapy like PEGPH20, which degrades hyaluronic acid in the extracellular matrix (ECM). A meta-analysis of these Randomized controlled trials (RCTs) to test the efficacy of PEGPH20 was performed. Methods: A systematic search was performed using PubMed, Embase, and Cochrane library without language limitations from inception to July 30, 2020. A total of 59 articles was identified, and 3 RCTs were included in the final analysis. The primary outcome was progression-free survival (PFS), and secondary outcomes were overall survival (OS), deaths from adverse events, thromboembolic events, serious adverse events (SAE), and febrile neutropenia. Results: There was no statistically significant improvement in PFS (HR= 0.94; 95%CI (0.79, 1.11)) in the PEGPH20 group when compared to the standard treatment/placebo group. There was no significant difference among OS (HR= 0.99, 95%CI (0.83, 1.17), deaths from adverse events (RR=0.97; 95%CI (0.54, 1.73)), thromboembolic events (RR= 1.49; 95%CI (0.92, 2.44)), and febrile neutropenia (RR= 0.88; 95%CI (0.45, 1.72), however, there was statistically significant increase in SAE (RR = 1.59; 95%CI (1.01, 2.52) in the PEGPH20 group compared to the placebo group. Conclusion: This meta-analysis showed that PEGPH20 did not improve the PFS or OS. Moreover, there is an increased incidence of serious adverse events with the use of PEGPH20 compared to standard therapies.

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Phase III Randomized Comparison of Gemcitabine Versus Gemcitabine Plus Capecitabine in Patients With Advanced Pancreatic Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.24.2446 ◽

2009 ◽

Vol 27 (33) ◽

pp. 5513-5518 ◽

Cited By ~ 484

Author(s):

David Cunningham ◽

Ian Chau ◽

Deborah D. Stocken ◽

Juan W. Valle ◽

David Smith ◽

...

Keyword(s):

Pancreatic Cancer ◽

Meta Analysis ◽

Performance Status ◽

Objective Response ◽

Locally Advanced ◽

Advanced Pancreatic Cancer ◽

Progression Free Survival ◽

Primary Outcome Measure ◽

Phase Iii ◽

Open Label

PurposeBoth gemcitabine (GEM) and fluoropyrimidines are valuable treatment for advanced pancreatic cancer. This open-label study was designed to compare the overall survival (OS) of patients randomly assigned to GEM alone or GEM plus capecitabine (GEM-CAP).Patients and MethodsPatients with previously untreated histologically or cytologically proven locally advanced or metastatic carcinoma of the pancreas with a performance status ≤ 2 were recruited. Patients were randomly assigned to GEM or GEM-CAP. The primary outcome measure was survival. Meta-analysis of published studies was also conducted.ResultsBetween May 2002 and January 2005, 533 patients were randomly assigned to GEM (n = 266) and GEM-CAP (n = 267) arms. GEM-CAP significantly improved objective response rate (19.1% v 12.4%; P = .034) and progression-free survival (hazard ratio [HR], 0.78; 95% CI, 0.66 to 0.93; P = .004) and was associated with a trend toward improved OS (HR, 0.86; 95% CI, 0.72 to 1.02; P = .08) compared with GEM alone. This trend for OS benefit for GEM-CAP was consistent across different prognostic subgroups according to baseline stratification factors (stage and performance status) and remained after adjusting for these stratification factors (P = .077). Moreover, the meta-analysis of two additional studies involving 935 patients showed a significant survival benefit in favor of GEM-CAP (HR, 0.86; 95% CI, 0.75 to 0.98; P = .02) with no intertrial heterogeneity.ConclusionOn the basis of our trial and the meta-analysis, GEM-CAP should be considered as one of the standard first-line options in locally advanced and metastatic pancreatic cancer.

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Prognostic and Clinicopathological Significance of C-Reactive Protein to Albumin Ratio in Patients With Pancreatic Cancer: A Meta-Analysis

Dose-Response ◽

10.1177/1559325820931290 ◽

2020 ◽

Vol 18 (2) ◽

pp. 155932582093129

Author(s):

Qinfen Xie ◽

Lidong Wang ◽

Shusen Zheng

Keyword(s):

Pancreatic Cancer ◽

Meta Analysis ◽

Disease Free Survival ◽

Progression Free Survival ◽

Cochrane Library ◽

Survival Outcomes ◽

C Reactive Protein ◽

Free Survival ◽

Albumin Ratio ◽

Reactive Protein

Background: This meta-analysis explored the correlation between the C-reactive protein to albumin ratio (CAR) and survival outcomes and clinicopathological characteristics in patients with pancreatic cancer. Methods: PubMed, Embase, Web of Science, and Cochrane Library databases were comprehensively searched through October 17, 2019. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were used to evaluate the association between CAR and overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) in pancreatic cancer. Results: The meta-analysis included 11 studies comprising 2271 patients. The pooled results showed that a high CAR was predictive of worse OS (HR = 1.84, 95% CI = 1.65-2.06, P < .001), PFS (HR = 1.53, 95% CI = 1.27-1.85, P < .001), and DFS (HR = 1.77, 95% CI = 1.30-2.41, P < .001). An elevated CAR was also associated with male sex (OR = 1.38, 95% CI = 1.10-1.74, P = .006). Conclusion: Elevated pretreatment CAR effectively predicts inferior survival outcomes in patients with pancreatic cancer and may be a powerful prognostic indicator for these patients.

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Pharmacoethnicity of FOLFIRINOX versus gemcitabine plus nab-paclitaxel in metastatic pancreatic cancer: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-99647-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yoon Suk Lee ◽

Jong-chan Lee ◽

Jae-Hyeong Kim ◽

Jaihwan Kim ◽

Jin-Hyeok Hwang

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Survival Benefit ◽

Meta Analysis ◽

Progression Free Survival ◽

Metastatic Pancreatic Cancer ◽

Cochrane Library ◽

Chemotherapeutic Regimen ◽

Free Survival ◽

Ethnic Subgroups

AbstractTreatment outcomes between FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) and GNP (gemcitabine with albumin-bound paclitaxel) as first-line chemotherapy regimens for metastatic pancreatic cancer (PC) were assessed according to ethnic groups categorized as Western or Asian subgroups. PubMed, EMBASE, and Cochrane library were searched. Thirteen studies were eligible in this meta-analysis. Overall survival was not significantly different between FOLFIRINOX and GNP (HR 1.00, 95% CI 0.83–1.20, P = 0.990). However, the Western subgroup showed a higher survival benefit for FOLFIRINOX over GNP (HR 0.84, 95% CI 0.74–0.95, P = 0.006) whereas the Asian subgroup showed the survival benefit for GNP over FOLFIRINOX (HR 1.29, 95% CI 1.03–1.60, P = 0.030). Progression free survival was not significantly different between the two regimens in the Western subgroup (HR 1.01, 95% CI 0.84–1.20, P = 0.950) and the Asian subgroup (HR 1.13, 95% CI 0.97–1.33, P = 0.110). Occurrence of febrile neutropenia was significantly higher in FOLFIRINOX at both ethnic subgroups; however, that of peripheral neuropathy was significantly higher only in GNP of the Asian subgroup. Therefore, pharmacoethnicity might be a factor worth considering when deciding on a frontline chemotherapeutic regimen although the overall survival was not significantly different between FOLFIRINOX and GNP for metastatic PCs.

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The Role of FOLFIRINOX in Advanced Pancreatic Cancer: A Meta-analysis

10.21203/rs.3.rs-290063/v1 ◽

2021 ◽

Author(s):

Nannan Du ◽

Fengyan Zhou ◽

Jiaze Hong ◽

Derry Minyao Ng ◽

Tong Yang ◽

...

Keyword(s):

Pancreatic Cancer ◽

Meta Analysis ◽

White Blood Cells ◽

Advanced Pancreatic Cancer ◽

Progression Free Survival ◽

Cochrane Library ◽

Hematological Toxicity ◽

Efficacy And Safety ◽

Potential Benefits

Abstract BackgroundThe prognosis of pancreatic cancer (PC) is extremely poor and most patients with metastatic PC still receive palliative care. Here, we report the efficacy and safety of FOLFIRINOX (oxaliplatin, irinotecan, leucovorin, 5-fluorouracil) in the treatment of metastatic PC.MethodsWe searched PubMed, Web of Science, EBSCO, and Cochrane library databases for articles that described efficacy and safety of FOLFIRINOX in patients with metastatic PC, from their inception to July 2020. The primary outcomes targeted included overall survival (OS) and progression-free survival (PFS).ResultsWe found that FOLFIRINOX could directly improve OS rate of patients with metastatic PC (HR: 0.76, 95% Cl: 0.67-0.86, p<0.001), but had no benefit on PFS. Results from subgroup analyses showed that FOLFIRINOX had superior benefits than mono-chemotherapy (HR: 0.59, 95% Cl: 0.52-0.67, p<0.001), followed by FOLFIRINOX versus combination chemotherapy (HR: 0.76, 95% Cl: 0.61-0.95, p<0.001). The result of FOLFIRINOX versus nab-paclitaxel + gemcitabine had no benefit (HR: 0.91, 95% Cl: 0.82-1.02, p>0.05). The main adverse events (AEs) targeted hematological toxicity and the gastrointestinal system, and included febrile neutropenia, a reduction in white blood cells and appetite, as well as diarrhea.ConclusionThese findings indicated that FOLFIRINOX has potential benefits for the prognosis of patients with metastatic PC. Furthermore, there is no difference between the regimen of FOLFIRINOX and nab-paclitaxel + gemcitabine in this study. The application of FOLFIRINOX should be according to the actual situation of the patients and the experience of the doctors.

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The Prognostic Value of Intratumoral and Peritumoral Tumor-Infiltrating FoxP3+Treg Cells in of Pancreatic Cancers: A Meta-Analysis

10.21203/rs.3.rs-651950/v1 ◽

2021 ◽

Author(s):

Lingyu Hu ◽

Mingyuan Zhu ◽

Yiyu Shen ◽

Zhengxiang Zhong ◽

Bin Wu

Keyword(s):

Pancreatic Cancer ◽

Prognostic Value ◽

Meta Analysis ◽

Disease Free Survival ◽

Progression Free Survival ◽

Tumor Infiltrating Lymphocytes ◽

Treg Cells ◽

Cochrane Library ◽

Free Survival ◽

The Impact

Abstract Background: Tumor-infiltrating lymphocytes (TILs) are major participants in the tumor microenvironment. The prognostic value of TILs in patients with pancreatic cancer is still controversial. Methods: The aim of our meta-analysis was to determine the impact of FoxP3+Treg cells on the survival of pancreatic cancer patients.We searched for related studies in PubMed, EMBASE, Ovid and Cochrane Library from the time the databases were established to Mar 30, 2017. We identified studies reporting the prognostic value of FoxP3+Treg cells in patients with pancreatic cancer. Overall survival (OS) and disease-free survival (DFS)/progression-free survival (PFS)/relapse-free survival (RFS) were investigated by pooling the data. The pooled hazard ratios (HRs) with 95% confidence intervals (95% CI) were used to evaluate the association between FoxP3+Treg cells and survival outcomes of pancreatic cancer patients.A total of 972 pancreatic cancer patients from 8 studies were included in our meta-analysis. Results: High levels of infiltration with FoxP3+Treg cells were significantly associated with poor OS (HR=2.13; 95% CI: 1.64–2.77; P<0.05) and poor DFS/PFS/RFS (HR=1.70; 95% CI: 1.04 ~ 2.78; P< 0.05). Similar results were also observed in peritumoral tissue; high levels of FoxP3+Treg cells were associated with poor OS (HR =2.1795% CI, CI: 1.50–3.13).Conclusion: This meta-analysis indicated that high levels of intratumoral or peritumoral FoxP3+Treg cell infiltration could be recognized as a negative factor in the prognosis of pancreatic cancer.

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The prognostic value of intratumoral and peritumoral tumor-infiltrating FoxP3+Treg cells in of pancreatic adenocarcinoma: a meta-analysis

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02420-1 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Lingyu Hu ◽

Mingyuan Zhu ◽

Yiyu Shen ◽

Zhengxiang Zhong ◽

Bin Wu

Keyword(s):

Pancreatic Cancer ◽

Cancer Patients ◽

Prognostic Value ◽

Meta Analysis ◽

Disease Free Survival ◽

Progression Free Survival ◽

Treg Cells ◽

Cochrane Library ◽

Free Survival ◽

The Impact

Abstract Background Tumor-infiltrating lymphocytes (TILs) are major participants in the tumor microenvironment. The prognostic value of TILs in patients with pancreatic cancer is still controversial. Methods The aim of our meta-analysis was to determine the impact of FoxP3+Treg cells on the survival of pancreatic cancer patients. We searched for related studies in PubMed, EMBASE, Ovid, and Cochrane Library from the time the databases were established to Mar 30, 2017. We identified studies reporting the prognostic value of FoxP3+Treg cells in patients with pancreatic cancer. Overall survival (OS) and disease-free survival (DFS)/progression-free survival (PFS)/relapse-free survival (RFS) were investigated by pooling the data. The pooled hazard ratios (HRs) with 95% confidence intervals (95% CI) were used to evaluate the association between FoxP3+Treg cells and survival outcomes of pancreatic cancer patients. A total of 972 pancreatic cancer patients from 8 studies were included in our meta-analysis. Results High levels of infiltration with FoxP3+Treg cells were significantly associated with poor OS (HR=2.13; 95% CI 1.64–2.77; P<0.05) and poor DFS/PFS/RFS (HR=1.70; 95% CI 1.04 ~ 2.78; P< 0.05). Similar results were also observed in the peritumoral tissue; high levels of FoxP3+Treg cells were associated with poor OS (HR =2.1795% CI, CI 1.50–3.13). Conclusion This meta-analysis indicated that high levels of intratumoral or peritumoral FoxP3+Treg cell infiltration could be recognized as a negative factor in the prognosis of pancreatic cancer.

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Locally advanced or metastatic pancreatic tumors: Molecular biology may help to know it and to select the optimal treatment.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.201 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 201-201

Author(s):

Luca Faloppi ◽

Kalliopi Andrikou ◽

Cristian Loretelli ◽

Alessandra Mandolesi ◽

Maristella Bianconi ◽

...

Keyword(s):

Stem Cells ◽

Molecular Biology ◽

Locally Advanced ◽

Ductal Adenocarcinoma ◽

Pancreatic Tumors ◽

Molecular Characteristics ◽

Notch 1 ◽

Kras Mutations ◽

Primary Tumors ◽

Desmoplastic Reaction

201 Background: Pancreatic cancer have a multi step progression model with successive mutations like activation of KRAS and inactivation of SMAD 4. Various studies demonstrated that loss of SMAD 4 cooperate with an activating KRAS mutation to promote progression, leading to dysregulation of TGFb pathway. This plays a pivotal role in the formation of desmoplastic reaction by the activation of stellate cells. Stromal cells synthesize and secrete multiple proteins like SPARC which has been associated with worst prognosis. Early data have suggested that the identification of cancer stem cells in primary tumors is associated with shorter OS, resistance to therapy and metastatic potential. Emerging evidence suggest that the activation of the NOTCH 1 pathway is associated with molecular characteristics of stem cells. The aim of our study is to investigate the relationship and the potential prognostic role of these biomarkers. Methods: In 110 histological samples of pancreatic ductal adenocarcinoma were performed immunohistochemical evaluations of KRAS, and molecular biology assessment of NOTCH 1 CD133, OCT3/4, SMAD 4, SPARC. Results: Preliminary analysis showed lower rate of KRAS mutations (54%) and higher expression of NOTCH 1 in KRAS WT patients (57% vs 41%). Different expression of OCT3/4 and CD133 was found according to NOTCH1 expression. In patients with NOTCH1 overexpression, OCT3/4 is found overexpressed (59% vs 45%). Instead in patients with lower NOTCH1 expression CD133 is overexpressed (59% vs 42%). Furthermore KRAS WT compared to MT patients showed higher expression of SMAD4 (66% vs 37%) and lower expression of SPARC (44% vs 59%). Conclusions: Our data indicate that KRAS status can differentiate two prognostic categories of pancreatic tumors: one (KRAS MT) probably more aggressive and characterized by early metastatization, associated to desmoplastic reaction and stemness (higher SPARC and CD133), the other (KRAS WT) with a more favourable behavior, correlated with a prevalent local invasiveness, with lower desmoplasia and stemness profile (lower SPARC and higher OCT3/4). These data suggest that the latter tumors are good candidates to radiotherapy as a part of combinated treatment.

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Clinical outcome of initially unresectable pancreatic cancer patients: Conversion surgery after modified FOLFIRINOX or gemcitabine nab-paclitaxel.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.725 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 725-725

Author(s):

Yuta Ushida ◽

Yosuke Inoue ◽

Hiromichi Ito ◽

Yoshihiro Ono ◽

Takafumi Sato ◽

...

Keyword(s):

Pancreatic Cancer ◽

Disease Control ◽

Conversion Rate ◽

Locally Advanced ◽

Progression Free Survival ◽

Morbidity Rate ◽

Conversion Surgery ◽

Number Of Patients ◽

Significant Difference ◽

Better Than

725 Background: Although pancreatic cancer (PC) is unfavorable clinical entity, the prognosis of resectable PC has been improving due to perioperative chemotherapy. Meanwhile, the prognosis of unresectable (UR) PC remains poor. In highly selected patients, however, conversion surgery (CS) has been performed with good outcome. Indication criteria of CS remain unestablished because the number of patients who underwent CS was very small in each institution. Methods: From 2014 to 2018, 485 consecutive patients with UR-PC who received modified FOLFIRINOX (mFFX) / Gemcitabine Nab-Paclitaxel (GnP) chemotherapy were reviewed. Among them, patients with disease control for more than 8 months were enrolled and divided into two groups; patients who underwent CS (CS group) and patients who did not undergo CS (non-CS group). We compared clinical characteristics and survival outcomes between groups. Our surgical indications were as follows: 1) Decreasing trend in CA19-9, 2) With response for chemotherapy in image, 3) Disease control more than 8 months, 4) Decision in Cancer board as for metastatic cases. Results: In UR-PC patients, 358 patients had distant metastasis (MPC) and 127 patients had locally advanced (LA) PC. The overall survival (OS), progression free survival (PFS) and conversion rate of LAPC were significantly better than MPC (OS; 21 vs. 13 months, PFS; 12 vs. 7 months, Conversion rate; 16 vs. 5 %, p < 0.001). Chemotherapy regimen (mFFX/GnP) had no significant difference in survival outcome. Between CS group (n = 39) with non-CS group (n = 160), age, sex, body mass index, location of lesion, CEA, CA19-9, regimen of chemotherapy and histology had no significant differences. The median survival time of CS group was significantly better than that of non-CS group (OS; NA vs. 21 months, p < 0.001, PFS; 24 vs. 14 months, p = 0.01). In CS group, median operative duration was 509 minutes, blood loss was 735 ml, hospital stay was 26 days, and there was no 90-days mortality case. Conclusions: In our retrospective study, CS for UR-PC can be safely performed, and among carefully selected patients, reasonable short and long term outcomes can be obtained without acceptable morbidity rate.

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