Abstract
Pancreatectomy with arterial resection is a treatment option in selected patients with locally advanced pancreatic cancer. This study aimed to identify factors predicting cancer-specific survival in this patient population. A single-Institution prospective database was used. Pre-operative prognostic factors were identified and used to develop a prognostic score. Matching with pathologic parameters was used for internal validation. In a patient population with a median Ca 19.9 level of 19.8 U/mL(IQR: 7.1–77), cancer-specific survival was predicted by: metabolic deterioration of diabetes (OR = 0.22, p = 0.0012), platelet count (OR = 1.00; p = 0.0013), serum level of Ca 15.3 (OR = 1.01, p = 0.0018) and Ca 125 (OR = 1.02, p = 0.00000137), neutrophils-to-lymphocytes ratio (OR = 1.16; p = 0.00015), lymphocytes-to-monocytes ratio (OR = 0.88; p = 0.00233), platelets-to-lymphocytes ratio (OR = 0.99; p = 0.00118), and FOLFIRINOX neoadjuvant chemotherapy (OR = 0.57; p = 0.00144). A prognostic score was developed and three risk groups were identified. Harrell’s C-Index was 0.74. Median cancer-specific survival was 16.0 months (IQR: 12.3–28.2) for the high-risk group, 24.7 months (IQR: 17.6–33.4) for the intermediate-risk group, and 39.0 months (IQR: 22.7–NA) for the low-risk group (p = 0.0003). Matching the three risk groups against pathology parameters, N2 rate was 61.9, 42.1, and 23.8% (p = 0.04), median value of lymph-node ratio was 0.07 (IQR: 0.05–0.14), 0.04 (IQR:0.02–0.07), and 0.03 (IQR: 0.01–0.04) (p = 0.008), and mean value of logarithm odds of positive nodes was − 1.07 ± 0.5, − 1.3 ± 0.4, and − 1.4 ± 0.4 (p = 0.03), in the high-risk, intermediate-risk, and low-risk groups, respectively. An online calculator is available at www.survivalcalculator-lapdac-arterialresection.org. The prognostic factors identified in this study predict cancer-specific survival in patients with locally advanced pancreatic cancer and low Ca 19.9 levels undergoing pancreatectomy with arterial resection.
Highlights
The incidence of pancreatic ductal adenocarcinoma (PDAC) is increasing, possibly making this tumor type the second leading cause of cancer-related mortality by the year 2030 [1].This high mortality is mainly related to the biological aggressiveness of PDAC with early haematogenous dissemination [2]
After we showed that this approach did not improve survival when compared to palliation [6], we refined our selection criteria to include only patients who had received neoadjuvant chemotherapy [15].The new approach led to improvement in both median survival time and disease-free survival time, despite we were yet unable to predict survival in the individual patient
P-Ar was performed in 105 patients (5.8%), including 16 isolated arterial resections (0.8%) and 89 combined arterial and venous resections (4.9%)
Summary
The incidence of pancreatic ductal adenocarcinoma (PDAC) is increasing, possibly making this tumor type the second leading cause of cancer-related mortality by the year 2030 [1].This high mortality is mainly related to the biological aggressiveness of PDAC with early haematogenous dissemination [2]. The first group includes patients with tumor invasion or abutment > 180° of. Updates in Surgery (2021) 73:233–249 the celiac trunk and the superior mesenteric artery (SMA), that are classified as stage 3 according to the AJCC [5]. In many of these patients, the superior mesenteric/portal vein is involved, making surgery extremely complex [6,7,8]. The overall judgment of unresectability in these patients is mostly based on anticipated high morbidity and mortality [7, 9, 10]not rewarded by an immediately evident survival advantage [6, 9]
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