Abstract
Pathological assessments of the treatment effect are critical for predicting patient outcomes after surgery. This study included 82 localized pancreatic cancer, 40 of whom were treated with neoadjuvant therapy (NAT) using four courses of gemcitabine plus nab-paclitaxel (GnP) followed by pancreatectomy (GnP group). The remaining 42 patients were treated with upfront pancreatectomy (UP) followed by adjuvant chemotherapy (UP group). We reviewed clinicopathological data of these patients to assess differences between the GnP and UP groups and further evaluate the prognostic impact of residual tumors after GnP treatment. Adjuvant treatment (S1, GnP or gemcitabine) was administered for 36 patients in the GnP group and 33 patients in the UP group. Compared to the UP group, the GnP group showed lower serum CA19-9 levels, microscopic tumor volume, and tumor-stroma ratio and decreased number of lymph node metastasis and vascular invasion. Higher incidence of encapsulating fibrosis was observed in the GnP group than in the UP group. Relative to the UP group (69%), a higher R0 rate was observed in the GnP group (85%). As for prognosis, encapsulating fibrosis was correlated with the overall survival of patients in the GnP group. However, overall survival did not show any correlation with other clinicopathological factors, including tumor reduction ratio (determined by computed tomography) and tumor regression grade (determined following criteria of Evans’ grading system or those of the College of American Pathologists). In conclusion, the present study revealed that GnP-induced encapsulating fibrosis could predict patients’ outcome. Nevertheless, large cohort studies are warranted to further evaluate the prognostic value of fibrosis, possibly with the help of imaging and biomarkers.
Highlights
Owing to aggressive local growth and distant metastasis, only 15%-20% of pancreatic cancer patients can be treated surgically
Encapsulating fibrosis following neoadjuvant chemotherapy in patients with pancreatic cancer treated with Neoadjuvant therapy (NAT) using four courses of gemcitabine and nab-paclitaxel (GnP) followed by pancreatectomy (GnP group)
Since the selection of our treatment strategy methods was based on resectability, there was a selection bias that resulted in the GnP group mainly consisting of patients with borderline resectable cancers (95%) while the upfront pancreatectomy (UP) group mainly comprised patients with resectable cancer (74%; Table 1)
Summary
Owing to aggressive local growth and distant metastasis, only 15%-20% of pancreatic cancer patients can be treated surgically. Encapsulating fibrosis following neoadjuvant chemotherapy in patients with pancreatic cancer high frequency of recurrence and low 5-year survival rate of 20%.[1] Gemcitabine has been considered the standard therapeutic agent used in both adjuvant therapy and treatment of metastatic disease [2, 3]; recently FOLFIRINOX [4] or a combination of gemcitabine and nab-paclitaxel (GnP)[5] showed a substantial improvement in survival compared to gemcitabine monotherapy. Neoadjuvant therapy (NAT) has been shown to improve the outcome of pancreatic cancer treatment [6,7,8,9,10] by increasing the proportion of patients that can be treated surgically to reduce the tumor size. NAT might eradicate micrometastasis in remote organs.[11]
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