Abstract
BackgroundPostoperative chemotherapy is beneficial for many pancreatic cancer patients. However, some patients require dose reduction or the discontinuation of adjuvant chemotherapy because of adverse treatment-related effects. In this study, we aimed to evaluate two main outcomes. First, we evaluated the clinicopathological factors affecting patient disease-free survival (DFS) and overall survival (OS) following upfront surgery. Second, we evaluated the factors that influence the continuity of adjuvant chemotherapy.MethodsFifty-four patients with resected pancreatic cancer were enrolled. First, we evaluated the clinicopathological factors affecting postoperative survival using the Kaplan-Meier method and Cox regression method. Next, factors affecting the continuity of adjuvant chemotherapy were analyzed using multiple logistic regression analysis.ResultsUnivariate and multivariate analyses revealed that positive LN metastasis (HR (95% CI) 6.329 (2.381–16.95); p < 0.001) and relative dose intensity (RDI) < 80% for adjuvant chemotherapy (HR (95% CI) 5.154 (1.761–15.15); p = 0.003) were independent predictive factors for DFS. Regarding OS, extended dissection of the nerve plexus around the superior mesenteric artery (SMA) (HR (95% CI) 4.504 (1.721–11.76); p = 0.002), positive microscopic surgical margin (HR (95% CI) 5.565 (1.724–17.96); p = 0.004), and adjuvant chemotherapy of RDI < 80% (HR (95% CI) 3.534 (1.135–2.667); p = 0.029) were also independent predictive factors. Moreover, the level of RDI significantly correlated with DFS and OS. Multiple logistic regression analysis revealed that low RDI was significantly associated with postoperative body weight loss (BWL) ≥ 10%.ConclusionsThe following factors were significantly associated with poor survival: extended dissection of the nerve plexus around the SMA, lymph node metastasis, residual tumor, and RDI of the adjuvant chemotherapy. Patient’s prognosis with adjuvant chemotherapy of RDI < 80% was worse. BWL ≥10% was the most important factor affecting the continuity of adjuvant chemotherapy. Perioperative nutritional intervention is necessary for patients who receive adjuvant chemotherapy for advanced pancreatic cancer.
Highlights
Postoperative chemotherapy is beneficial for many pancreatic cancer patients
The level of relative dose intensity (RDI) significantly correlated with disease-free survival (DFS) and overall survival (OS) for the adjuvant (+) patients, respectively (Fig. 3)
We identified factors including extended dissection of the nerve plexus around the superior mesenteric artery (SMA), lymph node metastasis, residual tumor, and adjuvant chemotherapy of RDI < 80% as prognostic indicator
Summary
Postoperative chemotherapy is beneficial for many pancreatic cancer patients. some patients require dose reduction or the discontinuation of adjuvant chemotherapy because of adverse treatmentrelated effects. We evaluated the clinicopathological factors affecting patient disease-free survival (DFS) and overall survival (OS) following upfront surgery. We evaluated the factors that influence the continuity of adjuvant chemotherapy. Surgical resection is the only potentially curative approach for pancreatic cancer when the disease is localized. Upfront surgery followed by adjuvant chemotherapy is recommended in patients with potentially resectable pancreatic cancer by the European Society for Medical Oncology (ESMO) and National Comprehensive Cancer Network (NCCN) guidelines [5, 6]. Patients with borderline resectable cancer should be considered for neoadjuvant chemotherapy. The best regimens in the neoadjuvant setting are still undetermined, FOLFIRINOX or Nab-paclitaxel are promising in patients with borderline resectable or locally advanced disease [8, 9]
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