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Survival Analysis in Patients with Pancreatic Ductal Adenocarcinoma Undergoing Chemoradiotherapy Followed by Surgery According to the International Consensus on the 2017 Definition of Borderline Resectable Cancer
- Source :
- Cancers; Volume 10; Issue 3; Pages: 65, Cancers, Cancers, Vol 10, Iss 3, p 65 (2018)
- Publication Year :
- 2018
- Publisher :
- Multidisciplinary Digital Publishing Institute, 2018.
-
Abstract
- Background: The aim of this study was to validate a new definition of borderline resectable pancreatic ductal adenocarcinoma (PDAC) provided by the 2017 international consensus on the basis of three dimensions of anatomical (A), biological (B), and conditional (C) factors, using the data of the patients who had been registered for our institutional protocol of chemoradiotherapy followed by surgery (CRTS) for localized patients with PDAC. Methods: Among 307 consecutive patients pathologically diagnosed with localized PDAC who were enrolled in our CRTS protocol from February 2005 to December 2016, we selected 285 patients who could be re-evaluated after CRT. These 285 patients were classified according to international consensus A definitions as follows: R (resectable; n = 62), BR-PV (borderline resectable, superior mesenteric vein (SMV)/portal vein (PV) involvement alone; n = 27), BR-A (borderline resectable, arterial involvement; n = 50), LA (locally advanced; n = 146). Disease-specific survival (DSS) was analyzed according to A, B (serum CA 19-9 levels and lymph node metastasis diagnosed by computed tomography findings before CRT), and C factors (performance status (PS)) factors. Results: The rates of resection and R0 resection were similar between R (83.9 and 98.0%) and BR-PV (85.2 and 95.5%), but much lower in BR-A (70.0 and 84.8%) and LA (46.6 and 62.5%). DSS evaluated by median survival time (months) showed a similar trend to surgical outcomes: 33.7 in R, 27.3 in BR-PV, 18.9 in BR-A and 19.3 in LA, respectively. DSS in R patients with CA 19-9 levels > 500 U/mL was significantly poorer than in patients with CA 19-9 levels ≤ 500 U/mL, but there were no differences in DSS among BR-PV, BR-A, and LA patients according to CA 19-9 levels. Regarding lymph node metastasis, there was no significant difference in DSS according to each resectability group. DSS in R patients with PS ≥ 2 was significantly worse than in patients with PS 0-1. Conclusions: The international consensus on the definition of BR-PDAC based on three dimensions of A, B, and C is useful and practicable because prognosis of PDAC patients is influenced by anatomical factors as well as biological and conditional factors, which in turn may help to decide treatment strategy.
- Subjects :
- Cancer Research
medicine.medical_specialty
Pancreatic ductal adenocarcinoma
lcsh:RC254-282
Article
03 medical and health sciences
0302 clinical medicine
medicine.artery
medicine
performance status
portal vein
superior mesenteric artery
CA 19-9
lymph node metastasis
Superior mesenteric artery
Superior mesenteric vein
Survival analysis
Performance status
business.industry
Cancer
medicine.disease
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Surgery
Oncology
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
CA19-9
business
Chemoradiotherapy
Subjects
Details
- Language :
- English
- ISSN :
- 20726694
- Database :
- OpenAIRE
- Journal :
- Cancers; Volume 10; Issue 3; Pages: 65
- Accession number :
- edsair.doi.dedup.....268539b4e928debbf3fb5e15cfa1ac30
- Full Text :
- https://doi.org/10.3390/cancers10030065