Preoperative Gemcitabine-based Chemoradiation Therapy for Borderline Resectable Pancreatic Cancer: Impact of Venous and Arterial Involvement Status on Surgical Outcome and Pattern of Recurrence.

Abstract

To evaluate the outcome of preoperative gemcitabine-based chemoradiation therapy (CRT) for borderline resectable pancreatic cancer (BRPC), focusing on the associations among the tumor-vascular relationship, surgical outcomes, and pattern of recurrence. Among the various multimodal treatment strategies for pancreatic cancer, preoperative CRT and subsequent surgery is 1 promising strategy for BRPC. A total of 184 patients with BRPC received preoperative CRT. BRPC was classified as follows, based on radiographic findings before the initiation of preoperative CRT: BR-V, a tumor involving the portal-superior mesenteric vein without arterial involvement; and BR-A, a tumor with the involvement of a relevant major artery. We assessed the association of these 2 subgroups with the following parameters: (1) resection rate, (2) survival, and (3) pattern of recurrence. The resection rate of BR-V cases (84%) was significantly higher than that of BR-A cases (57%) (P < 0.001). The 5-year survival rates of the resected BR-V and BR-A cases were 51% and 25%, respectively (P = 0.003). The 5-year cumulative incidence of distant recurrence was significantly higher in the BR-A cases compared with the BR-V cases (67% vs 54%, P = 0.006); however, the 5-year cumulative incidence of local recurrence was not significantly different between the groups. In BRPC, arterial involvement was associated with impaired outcome regarding resection rate and survival, possibly due to the difference in the underlying pathophysiology between BR-V and the advanced nature of BR-A as a systemic disease.