Cargando…

Optimal Upfront Treatment in Surgically Resectable Pancreatic Cancer Candidates: A High-Volume Center Retrospective Analysis

Pancreatic adenocarcinoma is a devastating disease with only 15–20% of patients resectable at diagnosis. Neoadjuvant chemotherapy for this cohort is becoming increasingly popular; however, there are no published randomized trials that support the use of neoadjuvant chemotherapy over upfront surgery...

Descripción completa

Detalles Bibliográficos
Autores principales: Maloney, Sarah, Itchins, Malinda, Arena, Jennifer, Sahni, Sumit, Howell, Viive M., Hayes, Sarah A., Gill, Anthony J., Clarke, Stephen J., Samra, Jaswinder, Mittal, Anubhav, Pavlakis, Nick
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8235361/
https://www.ncbi.nlm.nih.gov/pubmed/34207372
http://dx.doi.org/10.3390/jcm10122700
_version_ 1783714299352449024
author Maloney, Sarah
Itchins, Malinda
Arena, Jennifer
Sahni, Sumit
Howell, Viive M.
Hayes, Sarah A.
Gill, Anthony J.
Clarke, Stephen J.
Samra, Jaswinder
Mittal, Anubhav
Pavlakis, Nick
author_facet Maloney, Sarah
Itchins, Malinda
Arena, Jennifer
Sahni, Sumit
Howell, Viive M.
Hayes, Sarah A.
Gill, Anthony J.
Clarke, Stephen J.
Samra, Jaswinder
Mittal, Anubhav
Pavlakis, Nick
author_sort Maloney, Sarah
collection PubMed
description Pancreatic adenocarcinoma is a devastating disease with only 15–20% of patients resectable at diagnosis. Neoadjuvant chemotherapy for this cohort is becoming increasingly popular; however, there are no published randomized trials that support the use of neoadjuvant chemotherapy over upfront surgery in resectable disease. This retrospective cohort analysis was conducted to compare both treatment pathways and to identify any potential prognostic markers. Medical records from one large volume pancreatic cancer center from 2013–2019 were reviewed and 126 patients with upfront resectable disease were analyzed. Due to a change in practice in our center patients treated prior to December 2016 received upfront surgery and those treated after this date received neoadjuvant chemotherapy. Of these, 86 (68%) patients were treated with upfront surgery and 40 (32%) of patients were treated with neoadjuvant chemotherapy. Our results demonstrated that patients treated with upfront surgery with early-stage (1a) disease had a longer median OS compared to those treated with neoadjuvant chemotherapy (24 vs. 21 months, p = 0.028). This survival difference was not evident for all patients (regardless of stage). R0 resections were similar between groups (p = 0.605). We identified that both tumor viability (in neoadjuvant chemotherapy-treated patients) and tumor grade were useful prognostic markers. Upfront surgery for certain patients with low volume disease may be suitable despite the global trend towards neoadjuvant chemotherapy for all upfront resectable patients. A prospective clinical trial in this cohort incorporating biomarkers is needed to determine optimal therapy pathway.
format Online
Article
Text
id pubmed-8235361
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-82353612021-06-27 Optimal Upfront Treatment in Surgically Resectable Pancreatic Cancer Candidates: A High-Volume Center Retrospective Analysis Maloney, Sarah Itchins, Malinda Arena, Jennifer Sahni, Sumit Howell, Viive M. Hayes, Sarah A. Gill, Anthony J. Clarke, Stephen J. Samra, Jaswinder Mittal, Anubhav Pavlakis, Nick J Clin Med Article Pancreatic adenocarcinoma is a devastating disease with only 15–20% of patients resectable at diagnosis. Neoadjuvant chemotherapy for this cohort is becoming increasingly popular; however, there are no published randomized trials that support the use of neoadjuvant chemotherapy over upfront surgery in resectable disease. This retrospective cohort analysis was conducted to compare both treatment pathways and to identify any potential prognostic markers. Medical records from one large volume pancreatic cancer center from 2013–2019 were reviewed and 126 patients with upfront resectable disease were analyzed. Due to a change in practice in our center patients treated prior to December 2016 received upfront surgery and those treated after this date received neoadjuvant chemotherapy. Of these, 86 (68%) patients were treated with upfront surgery and 40 (32%) of patients were treated with neoadjuvant chemotherapy. Our results demonstrated that patients treated with upfront surgery with early-stage (1a) disease had a longer median OS compared to those treated with neoadjuvant chemotherapy (24 vs. 21 months, p = 0.028). This survival difference was not evident for all patients (regardless of stage). R0 resections were similar between groups (p = 0.605). We identified that both tumor viability (in neoadjuvant chemotherapy-treated patients) and tumor grade were useful prognostic markers. Upfront surgery for certain patients with low volume disease may be suitable despite the global trend towards neoadjuvant chemotherapy for all upfront resectable patients. A prospective clinical trial in this cohort incorporating biomarkers is needed to determine optimal therapy pathway. MDPI 2021-06-18 /pmc/articles/PMC8235361/ /pubmed/34207372 http://dx.doi.org/10.3390/jcm10122700 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Maloney, Sarah
Itchins, Malinda
Arena, Jennifer
Sahni, Sumit
Howell, Viive M.
Hayes, Sarah A.
Gill, Anthony J.
Clarke, Stephen J.
Samra, Jaswinder
Mittal, Anubhav
Pavlakis, Nick
Optimal Upfront Treatment in Surgically Resectable Pancreatic Cancer Candidates: A High-Volume Center Retrospective Analysis
title Optimal Upfront Treatment in Surgically Resectable Pancreatic Cancer Candidates: A High-Volume Center Retrospective Analysis
title_full Optimal Upfront Treatment in Surgically Resectable Pancreatic Cancer Candidates: A High-Volume Center Retrospective Analysis
title_fullStr Optimal Upfront Treatment in Surgically Resectable Pancreatic Cancer Candidates: A High-Volume Center Retrospective Analysis
title_full_unstemmed Optimal Upfront Treatment in Surgically Resectable Pancreatic Cancer Candidates: A High-Volume Center Retrospective Analysis
title_short Optimal Upfront Treatment in Surgically Resectable Pancreatic Cancer Candidates: A High-Volume Center Retrospective Analysis
title_sort optimal upfront treatment in surgically resectable pancreatic cancer candidates: a high-volume center retrospective analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8235361/
https://www.ncbi.nlm.nih.gov/pubmed/34207372
http://dx.doi.org/10.3390/jcm10122700
work_keys_str_mv AT maloneysarah optimalupfronttreatmentinsurgicallyresectablepancreaticcancercandidatesahighvolumecenterretrospectiveanalysis
AT itchinsmalinda optimalupfronttreatmentinsurgicallyresectablepancreaticcancercandidatesahighvolumecenterretrospectiveanalysis
AT arenajennifer optimalupfronttreatmentinsurgicallyresectablepancreaticcancercandidatesahighvolumecenterretrospectiveanalysis
AT sahnisumit optimalupfronttreatmentinsurgicallyresectablepancreaticcancercandidatesahighvolumecenterretrospectiveanalysis
AT howellviivem optimalupfronttreatmentinsurgicallyresectablepancreaticcancercandidatesahighvolumecenterretrospectiveanalysis
AT hayessaraha optimalupfronttreatmentinsurgicallyresectablepancreaticcancercandidatesahighvolumecenterretrospectiveanalysis
AT gillanthonyj optimalupfronttreatmentinsurgicallyresectablepancreaticcancercandidatesahighvolumecenterretrospectiveanalysis
AT clarkestephenj optimalupfronttreatmentinsurgicallyresectablepancreaticcancercandidatesahighvolumecenterretrospectiveanalysis
AT samrajaswinder optimalupfronttreatmentinsurgicallyresectablepancreaticcancercandidatesahighvolumecenterretrospectiveanalysis
AT mittalanubhav optimalupfronttreatmentinsurgicallyresectablepancreaticcancercandidatesahighvolumecenterretrospectiveanalysis
AT pavlakisnick optimalupfronttreatmentinsurgicallyresectablepancreaticcancercandidatesahighvolumecenterretrospectiveanalysis