Clinical Impact of Neoadjuvant Chemotherapy and Chemoradiotherapy in Borderline Resectable Pancreatic Cancer: Analysis of 884 Patients at Facilities Specializing in Pancreatic Surgery

Yuichi Nagakawa, Yatsuka Sahara, Yuichi Hosokawa, Yoshiaki Murakami, Hiroki Yamaue, Sohei Satoi, Michiaki Unno, Shuji Isaji, Itaru Endo, Masayuki Sho, Tsutomu Fujii, Chie Takishita, Yosuke Hijikata, Shuji Suzuki, Shigeyuki Kawachi, Kenji Katsumata, Tetsuo Ohta, Takukazu Nagakawa, Akihiko Tsuchida

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)

Abstract

Background: The efficacy of neoadjuvant therapy (NAT), including neoadjuvant chemotherapy (NAC) and neoadjuvant chemo-radiotherapy (NACRT), for patients with borderline resectable pancreatic cancer (BRPC) has not been elucidated. This study aimed to clarify the efficacy of NAC and NACRT for patients with BRPC. Methods: The study analyzed the treatment outcomes of 884 patients treated for BRPC from 2011 to 2013. Treatment results were compared between upfront surgery and NAT and between NAC and NACRT using propensity score-matching analysis. Overall survival (OS) was calculated via intention-to-treat analyses. Results: The overall resection rates for the patients who underwent NAT were significantly lower than for the patients who underwent upfront surgery (75.1% vs 93.3%; p < 0.001). However, the R0 resection rate was significantly higher for NAT than for upfront surgery (p < 0.001). Additionally, the OS for the patients who received NAT was significantly longer than for those who underwent upfront surgery (median survival time [MST], 25.7 vs 19.0 months; p = 0.015). The lymph node rate for the patients with NACRT was significantly lower than for those who underwent NAC (p < 0.001). However, the resection rate for the NACRT cases was significantly lower than for the NAC cases (p = 0.041). The local recurrence rate for the NACRT cases was significantly lower than for the NAC cases (p = 0.002). However, OS did not differ significantly between NAC and NACRT (MST, 29.2 vs 22.5 months; p = 0.130). Conclusions: The study showed that NAT has potential benefit for patients with BRPC. Compared with NAC, NACRT decreased the rates for lymph node metastasis and local recurrence but did not improve the prognosis.

Original languageEnglish
Pages (from-to)1629-1636
Number of pages8
JournalAnnals of Surgical Oncology
Volume26
Issue number6
DOIs
Publication statusPublished - 2019 Jun 15

ASJC Scopus subject areas

  • Surgery
  • Oncology

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