Reconsideration of the clinical impact of neoadjuvant therapy in resectable and borderline resectable pancreatic cancer: A dual-institution collaborative clinical study

Suguru Yamada; Daisuke Hashimoto; Tomohisa Yamamoto; So Yamaki; Kenji Oshima; Kenta Murotani; Mitsugu Sekimoto; Akimasa Nakao; Sohei Satoi

doi:10.1016/j.pan.2024.03.012

Reconsideration of the clinical impact of neoadjuvant therapy in resectable and borderline resectable pancreatic cancer: A dual-institution collaborative clinical study

Pancreatology. 2024 Mar 26:S1424-3903(24)00073-5. doi: 10.1016/j.pan.2024.03.012. Online ahead of print.

Authors

Suguru Yamada¹, Daisuke Hashimoto², Tomohisa Yamamoto², So Yamaki², Kenji Oshima¹, Kenta Murotani³, Mitsugu Sekimoto⁴, Akimasa Nakao¹, Sohei Satoi⁵

Affiliations

¹ Department of Gastroenterological Surgery, Nagoya Central Hospital, Japan.
² Department of Surgery, Kansai Medical University, Japan.
³ Biostatistics Center, Graduate School of Medicine, Kurume University, Japan.
⁴ Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁵ Department of Surgery, Kansai Medical University, Japan; Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. Electronic address: satoi@hirakata.kmu.ac.jp.

PMID: 38548551
DOI: 10.1016/j.pan.2024.03.012

Abstract

Purpose: We investigated true indication of neoadjuvant therapy (NAT) in resectable pancreatic cancer and the optimal surgical timing in borderline resectable pancreatic cancer.

Methods: A total of 687 patients with resectable or borderline resectable pancreatic cancer were enrolled. Survival analysis was performed by intention-to-treat analysis and propensity score matching (PSM) was conducted.

Results: In resectable disease, the NAT group showed better overall survival (OS) compared with the upfront group. Multivariate analysis identified CA19-9 level (≥100 U/mL) and lymph node metastasis to be prognostic factors, and a tumor size of 25 mm was the optimal cut-off value to predict lymph node metastasis. There was no significant survival difference between patients with a tumor size ≤25 mm and CA19-9 < 100 U/mL and those in the NAT group. In borderline resectable disease, OS in the NAT group was significantly better than that in the upfront group. CEA (≥5 ng/mL) and CA19-9 (≥100 U/mL) were identified as prognostic factors; however, the OS of patients fulfilling these factors was worse than that of the NAT group.

Conclusions: NAT could be unnecessary in patients with tumor size ≤25 mm and CA19-9 < 100 U/mL in resectable disease. In borderline resectable disease, surgery should be delayed until tumor marker levels are well controlled.

Keywords: Borderline resectable; Neoadjuvant therapy; Pancreatic cancer; Prognosis; Resectable.