Abstract
Background and AimEffective multidisciplinary approaches for unresectable pancreatic cancer (UR‐PC) that include modern chemotherapeutic regimens and subsequent conversion surgery (CS) are being developed. The aim of this study was to evaluate outcomes of patients clinically diagnosed with UR‐PC, focusing on the efficacy of CS.MethodsPatients ineligible for two multicenter phase II studies conducted by the Hokkaido Pancreatic Cancer Study Group (HOPS) were recruited. Sequential treatment regimens, conversion to radical surgery, and overall survival (OS) were analyzed by multidetector computed tomography (MDCT)‐based UR factors. Univariate and multivariate analyses were performed to identify predictors of OS.ResultsSixty‐six of 247 intended recruits for HOPS studies from October 2013 to April 2016 were included. Unresectability was due to locally advanced (LA) disease and metastasis (M) in 42 and 24 patients, respectively. Induction therapy began with chemotherapy (CT) and chemoradiotherapy (CRT) in 44 and 17 patients, respectively, of whom 23 received modern CT regimens. Radical surgery was completed in 12 (LA, 10; M, two) with a median treatment interval of 10.3 months (range, 2‐32). Eleven patients (91.6%) achieved pathological R0 resection. Median OS was significantly longer in patients who underwent CS than those who did not (44.1 vs 14.5 months, P < 0.0001). CS was an independent predictor of OS (hazard ratio, 0.078; 95% confident interval, 0.017‐0.348; P = 0.001).ConclusionConversion surgery after a favorable response to sequential treatment might prolong survival in patients with UR‐PC. Precise diagnosis on MDCT followed by sequential multimodal anticancer treatment is essential.
Highlights
Pancreatic cancer (PC) is one of the most aggressive malignancies.[1]
conversion surgery (CS) was an independent predictor of overall survival (OS)
This multicenter, retrospective Hokkaido Pancreatic Cancer Study Group (HOPS) cohort study demonstrated that OS of patients who were clinically diagnosed with unresectable pan‐ creatic cancer (UR‐PC) and com‐ pleted CS after successful multidisciplinary induction treatment is significantly longer than OS in patients who did not, suggesting that a certain population of patients with UR‐PC benefit from CS
Summary
Pancreatic cancer (PC) is one of the most aggressive malignancies.[1]. In 2018, there were 44 330 estimated patients with PC‐related death in the USA and 34 990 patients in Japan, suggesting that PC is the fourth leading cause of cancer‐related death in both countries.[1,2]In the National Comprehensive Cancer Network (NCCN) guide‐ lines,[3] resectability is categorized as resectable (R), borderline resectable (BR), or unresectable (UR) based on multidetector com‐ puted tomography (MDCT) evaluation. More than 80% of patients are diagnosed with UR because of its high metastatic (M) potential.[5] Recent advances in anticancer treat‐ ment for locally advanced (LA) UR, or M‐PC facilitate good disease control; such patients sometimes convert to surgical resection.[6] This surgical strategy is called conversion surgery (CS).[7] Several reports on CS in patients with UR‐PC have shown that it has a favorable ef‐ fect on overall survival (OS).[6,8,9] In recent meta‐analyses of reports from 2009 to 2015, the rate of conversion from UR‐LA‐PC to sur‐ gery was 26% and OS ranged from 18.7 to 24.2 months.[10,11] The entire cohort examined in these meta‐analyses comprised patients recruited into clinical trials conducted before 2013. Univariate and multivariate analyses were performed to identify predictors of OS.
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