The investigation of prognostic factors and significance of neoadjuvant therapy for resectable pancreatic cancer

Abstract

Introduction: Pancreatic cancer (PDAC) has a highly malignant potential. In recent years, it was reported that neoadjuvant therapy (NAT) for borderline resectable PDAC would contribute to improvement of patients' prognosis, however, there is no evidence for NAT in resectable (R) PDAC. In this study, we aim to investigate the clinical significance of NAT and analyze prognostic parameters for head R PDAC patients. Methods: Consecutive all 143 patients with R PDAC were performed pancreaticoduodenectomy and total pancreatectomy in our department from 2002 to 2016. Among all, 130 and 13 patients were classified into surgery first (SF) group and NAT group, respectively. Results: Among NAT group, the combination of gemcitabine (Gem) and S-1 for 9 patients, the combination of Gem and nab-paclitaxel for 1 patient and carbon-ion radiotherapy (CIRT) for 4 patients, and CIRT with Gem for 1 patient were administrated as neoadjuvant therapies. Comparing between SF and NAT group, no significant differences were observed in the major clinico-pathological factors. In terms of clinical outcomes of patients, overall survival, disease free survival and recurrence site also did not show significant differences between these two groups. Initial CA19-9 >500 (P = 0.042), lymph nodes metastasis (P = 0.0025) and blood volume loss (P=0.0030) were considered as independent prognostic factors for overall survival in multivariate analysis. Conclusion: We demonstrated that initial CA19-9 level is an independent prognostic factor in R PDAC. The initial CA19-9 level will become a good indicator for determining the R PDAC patients who should be undergone NAT.