Prognostic impact of intraoperative peritoneal cytology after neoadjuvant therapy for potentially resectable pancreatic cancer

Shuichi Aoki, Masamichi Mizuma, Hiroki Hayashi, Shingo Yoshimachi, Tatsuo Hata, Takayuki Miura, Tatsuyuki Takadate, Shimpei Maeda, Kyohei Ariake, Kei Kawaguchi, Kunihiro Masuda, Masaharu Ishida, Hideo Ohtsuka, Kei Nakagawa, Takanori Morikawa, Fuyuhiko Motoi, Michiaki Unno

研究成果: Article査読

1 被引用数 (Scopus)

抄録

Background: Neoadjuvant therapy (NAT) is considered a potential approach to improve survival for patients with pancreatic adenocarcinoma (PA). The objective of this study was to identify the clinical implications of washing peritoneal cytology (CY) status after NAT. Methods: Between 2005 and 2016, 151 consecutive patients with resectable (R)/borderline resectable (BR) PA underwent NAT with intention of subsequent resection at our institution. Of them, 13 and 123 patients underwent pancreatectomies with positive (CY+) and negative (CY-) cytology, respectively, while the remaining 15 patients did not undergo resection due to gross metastases at laparotomy. The clinicopathological factors influencing overall survival were clarified by the uni- and multivariate analyses. Results: The postoperative overall survival (OS) and disease-free survival (DFS) were markedly worse in patients who underwent resection with CY+, compared with those who were CY- (median OS, 14.8 m vs 30.8 m, p = 0.026, and median DFS 6.0 m vs 15.1 m, p = 0.008). According to the resectability by NCCN guidelines, CY+ indicates worse prognosis than CY- in R-PA patients (mOS: 30.1 m vs 71.1 m: p = 0.080). Similarly, in BR-PA patients, CY+ showed the significantly worse prognosis than CY- (mOS: 13.8 m vs 24.5 m: p = 0.048), which prognosis is comparable with patients who did not undergo resection. The multivariate analysis revealed that resectability, CY status and the induction of adjuvant therapy were significant predictors of postoperative OS (p = 0.007: Hazard ratio 2.264, 0.040:2.094 and 0.002:3.246, respectively). Conclusions: CY+ is a significant predictor of poorer prognosis in PA patients after NAT. The subsequent pancreatectomies with CY+ after NAT do not contribute to prolonged survival.

本文言語English
ページ(範囲)1711-1717
ページ数7
ジャーナルPancreatology
20
8
DOI
出版ステータスPublished - 2020 12

ASJC Scopus subject areas

  • 内分泌学、糖尿病および代謝内科学
  • 肝臓学
  • 消化器病学

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