Resectable Pancreatic Cancer Research Articles

The implications of sarcopenia in the treatment and prognosis of pancreatic cancer

Sarcopenia is the subclinical loss of skeletal muscle and strength and has been extensively studied in both cancer and surgical patients. Patients with sarcopenia are particularly vulnerable to major physiological stressors including surgery and surgical complications. Sarcopenia has thus gained significant recognition as an important prognostic factor for both complications and survival in cancer patients. The aim of this review was to evaluate the current literature on the effect of sarcopenia on the treatment and prognosis of pancreatic cancer. The prevalence of sarcopenia in pancreatic cancer patients range between 20 and 65% due to the heterogeneous groups of patients, difference in disease stage, and the different methods of measuring sarcopenia. Sarcopenia would be more accurately assessed by utilizing both imaging and clinical data, such as frailty. Although malnutrition could be responsible for the attenuated healing process of pancreatic anastomosis the relationship between sarcopenia and outcome following pancreaticoduodenectomy is debated. Most studies showed a higher risk of postoperative pancreatic fistula formation in patients with concurrent sarcopenia and high fat mass (sarcopenic obesity). Sarcopenia seems generally to be associated with lower survival. The assessment of sarcopenia can therefore lead to changes in management strategy, patient selection, and improved informed consent prior to surgical resection of pancreatic cancer. An improved prediction of clinically relevant pancreatic fistula formation after pancreatic surgery using preoperative computed tomography scan, including a fistula risk score using sarcopenic obesity and subcutaneous fat area will be useful. Although treatment for sarcopenia still remains an area of research a protocol to improve nutrition and fitness preoperatively may improve sarcopenia and surgical outcome.

The prognostic role of lymphocyte-to-monocyte ratio in patients with resectable pancreatic cancer: a systematic review and meta-analysis.

This systematic review and meta-analysis examined whether the lymphocyte-to-monocyte ratio (LMR) can serve as an indicator for predicting the prognosis of patients with resectable pancreatic cancer. This meta-analysis was registered with PROSPERO: CRD42023461260. A systematic literature search was conducted in the PubMed, Embase, Cochrane, and Web of Science databases up to September 2023 to assess whether LMR can predict the prognosis of patients with resectable pancreatic cancer. The outcomes measured included subgroup analyses of overall survival (OS) with hazard ratios (HR) and confidence intervals of geographical region, patient population, and LMR threshold. A sensitivity analysis was also performed for OS and HR and confidence intervals were calculated for recurrence-free survival (RFS). A total of 14 eligible articles, comprising 4,019 patients, were included in the comprehensive analysis. The results of this comprehensive analysis indicate that LMR is a robust predictor of OS, demonstrating strong prognostic significance (HR = 0.55, 95% CI [0.44-0.69], I2 = 79%, P < 0.00001). This predictive significance extended to various types of pancreatic cancer, such as pancreatic ductal adenocarcinoma (HR = 0.73, 95% CI [0.57-0.93], I2 = 46%, P = 0.01), pancreatic neuroendocrine neoplasms (HR = 0.81, 95% CI [0.66-0.99], P = 0.04) and other subtypes (HR = 0.40, 95% CI [0.22-0.72], I2 = 89%, P < 0.00001), but not to pancreatic head cancer (HR = 0.46, 95% CI [0.16-1.13], I2 = 59%, P = 0.12). LMR retained its predictive value across different regions, including Asia (HR = 0.62, 95% CI [0.47-0.76], I2 = 68%, P < 0.0001), Europe (HR = 0.78, 95% CI [0.67-0.91], I2 = 0%, P = 0.002), and the Americas (HR = 0.14, 95% CI [0.08-0.24], I2 = 0%, P < 0.00001). Notably, both LMR cut-off values greater than or equal to three (HR = 0.62, 95% CI [0.47-0.82], I2 = 67%, P = 0.0009) and less than three (HR = 0.47, 95% CI [0.32-0.69], I2 = 85%, P = 0.0001) exhibited prognostic significance. The sensitivity analysis for OS confirmed the strong predictive value of LMR, whereas LMR did not exhibit predictive significance for RFS (HR = 0.35, 95% CI [0.09-1.32], I2 = 95%, P = 0.12). In both subgroups categorized by Newcastle-Ottawa Scale (NOS) scores of ≥7 (HR = 0.66, 95% CI [0.54-0.80], I2 = 53%, P = 0.04) and <7 (HR = 0.41, CI [0.23-0.72], I2 = 89%, P < 0.00001), LMR was demonstrated to have predictive value. Despite the observed heterogeneity and potential biases in the included studies, the findings of this study suggest that LMR may serve as a valuable predictor of OS in patients with resectable pancreatic cancer.

Liquid biopsy shows distinctive proteome of long-term recurrence free survival after resection of pancreatic cancer

Liquid biopsy shows distinctive proteome of long-term recurrence free survival after resection of pancreatic cancer

Results of venous resections in pancreatic cancer at our center

Results of venous resections in pancreatic cancer at our center

Barriers to initiation and completion of adjuvant chemotherapy after resection for pancreatic cancer

Barriers to initiation and completion of adjuvant chemotherapy after resection for pancreatic cancer

Nonsurvival advantages of neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer: a patient-level meta-analysis of randomized controlled trials

Nonsurvival advantages of neoadjuvant therapy versus upfront surgery in resectable pancreatic cancer: a patient-level meta-analysis of randomized controlled trials

The evaluation of biological borderline resectable pancreatic cancer in cases of resected anatomically resectable pancreatic cancer

The evaluation of biological borderline resectable pancreatic cancer in cases of resected anatomically resectable pancreatic cancer

Prediction of short- and long-term survival in resectable pancreatic cancer using deep learning histology

Prediction of short- and long-term survival in resectable pancreatic cancer using deep learning histology

The immune microenvironment of the pre-metastatic liver modulates patterns of recurrence in resectable pancreatic cancer

The immune microenvironment of the pre-metastatic liver modulates patterns of recurrence in resectable pancreatic cancer

Increase of complications and decrease of survival after endoscopic bile duct stenting: time to change management of jaundice in resectable pancreatic cancer

Increase of complications and decrease of survival after endoscopic bile duct stenting: time to change management of jaundice in resectable pancreatic cancer

An exploration of candidates for neoadjuvant treatment in resectable pancreatic cancer according to tumor-vessel relationship and CA 19-9 levels

An exploration of candidates for neoadjuvant treatment in resectable pancreatic cancer according to tumor-vessel relationship and CA 19-9 levels

Evaluating extended venous thromboembolism prophylaxis after pancreatic cancer resection

Evaluating extended venous thromboembolism prophylaxis after pancreatic cancer resection

A multicentre Prospective evaluation of Patient Related Outcome Measures (PROMS) and Health Related Quality of Life (HRQoL) in Patients with Resectable Pancreatic and Peripancreatic Cancer (PROMCAN Study)

A multicentre Prospective evaluation of Patient Related Outcome Measures (PROMS) and Health Related Quality of Life (HRQoL) in Patients with Resectable Pancreatic and Peripancreatic Cancer (PROMCAN Study)

Multicenter retrospective study on prognostic factors in resected pancreatic body cancer

Multicenter retrospective study on prognostic factors in resected pancreatic body cancer

Long-term outcomes for resectable pancreatic head cancer in patients >70 years old

Long-term outcomes for resectable pancreatic head cancer in patients >70 years old

A Prospective Randomized Control Study of Neo-adjuvant Chemo Radiation Followed by Surgery versus Upfront Surgery in Resectable and Borderline Resectable Pancreatic Head Cancer: Pilot Study

A Prospective Randomized Control Study of Neo-adjuvant Chemo Radiation Followed by Surgery versus Upfront Surgery in Resectable and Borderline Resectable Pancreatic Head Cancer: Pilot Study

Risk factors of early recurrence after radical resection for pancreatic cancer

Risk factors of early recurrence after radical resection for pancreatic cancer

Correlation between Angiotensin Inhibitor Administration and Longer Survival in Patients Who Underwent Curative Resection for Pancreatic Cancer.

The microenvironment of pancreatic ductal adenocarcinoma (PDAC) with extensive desmoplastic stroma contributes to aggressive cancer behavior. Angiotensin system inhibitors (ASIs) reduce stromal fibrosis and are a promising therapeutic strategy. The purpose of this study was to examine how ASIs affected the oncological results of patients who had their PDAC removed. A retrospective assessment was conducted on the clinicopathological and survival data of patients who received curative resection for PDAC at Severance Hospital between January 2012 and December 2019. A total of 410 participants (228 male and 182 female), with a median follow-up period of 12.8 months, were included in this study. Patients were divided into three groups, based on ASI use and history of hypertension: group 1, normotensive and never used ASI (n=210, 51.2%); group 2, ASI non-users with hypertension (n=50, 12.2%); and group 3, ASI users with hypertension (n=150, 36.6%). The three groups did not differ significantly in terms of age, sex, kind of operation, T and N stages, or adjuvant and neoadjuvant therapy. Moreover, there was no discernible difference in disease-free survival between those who used ASI and those who did not (p=0.636). The 5-year overall survival (OS) rates in groups 1, 2, and 3 were 52.6%, 32.3%, and 38.0%, respectively. However, the OS rate of ASI users was remarkably higher than that of non-users (p=0.016). In patients with resected PDAC, ASI is linked to longer survival rates. Furthermore, for individuals with hypertension, ASI in conjunction with conventional chemotherapy may be an easy and successful treatment option.

Prognostic impact of resection margin status on survival after neoadjuvant treatment for pancreatic cancer: systematic review and meta-analysis.

A greater than 1mm tumour-free resection margin (R0 >1mm) is a prognostic factor in upfront-resected pancreatic ductal adenocarcinoma. After neoadjuvant treatment (NAT); however, the prognostic impact of resection margin (R) status remains controversial. Randomised and non-randomised studies assessing the association of R status and survival in resected pancreatic ductal adenocarcinoma after NAT were sought by systematic searches of MEDLINE, Web of Science and CENTRAL. Hazard ratios (HR) and their corresponding 95% CI were collected to generate log HR using the inverse-variance method. Random-effects meta-analyses were performed and the results presented as weighted HR. Sensitivity and meta-regression analyses were conducted to account for different surgical procedures and varying length of follow-up, respectively. Twenty-two studies with a total of 4929 patients were included. Based on univariable data, R0 greater than 1 mm was significantly associated with prolonged overall survival (OS) (HR 1.76, 95% CI 1.57-1.97; P<0.00001) and disease-free survival (DFS) (HR 1.66, 95% CI 1.39-1.97; P<0.00001). Using adjusted data, R0 greater than 1 mm was significantly associated with prolonged OS (HR 1.65, 95% CI 1.39-1.97; P<0.00001) and DFS (HR 1.76, 95% CI 1.30-2.39; P=0.0003). Results for R1 direct were comparable in the entire cohort; however, no prognostic impact was detected in sensitivity analysis including only partial pancreatoduodenectomies. After NAT, a tumour-free margin greater than 1mm is independently associated with improved OS as well as DFS in patients undergoing surgical resection for pancreatic cancer.

Outcomes of Pancreatic Resections for Cancer after Preoperative Acute Pancreatitis

Outcomes of Pancreatic Resections for Cancer after Preoperative Acute Pancreatitis