Clinical implications of the serum CA19-9 level in “biological borderline resectability” and “biological downstaging” in the setting of preoperative chemoradiation therapy for pancreatic cancer

Takahashi, Hidenori; Yamada, Daisaku; Asukai, Kei; Wada, Hiroshi; Hasegawa, Shinobu; Hara, Hisashi; Shinno, Naoki; Ushigome, Hidetaka; Haraguchi, Naotsugu; Sugimura, Keijiro; Yamamoto, Keiji; Nishimura, Junichi; Yasui, Masayoshi; Omori, Takeshi; Miyata, Hiroshi; Ohue, Masayuki; Yano, Masahiko; Sakon, Masato; Ishikawa, Osamu

doi:10.1016/j.pan.2020.05.020

Cited by 31 publications

(29 citation statements)

References 42 publications

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“…In this setting, CRT was targeted not only to the primary pancreatic tumor, but also to the perivascular and retroperitoneal tissues for preventing local recurrence after surgery. CRT targeted to the primary pancreatic tumor was administered at a total radiation dose of 50 Gy/25 fractions/5 weeks, whereas CRT targeted to the CA/SMA, retroperitoneal soft tissue, and para-aortic region was administered at 60 Gy/25 fractions/5 weeks [ 18 ] with a simultaneous integrated boost. During CRT, single-agent chemotherapy with gemcitabine or S-1 (an oral fixed-dose combination of three active drugs; tegafur (oral prodrug of fluorouracil), gimeracil, and oteracil) was administered as a radiosensitizer.…”

Section: Methodsmentioning

confidence: 99%

The Survival Benefit of Chemoradiotherapy following Induction Chemotherapy with Gemcitabine Plus Nab-Paclitaxel for Unresectable Locally Advanced Pancreatic Cancer

Takada

Ikezawa

Daiku

et al. 2021

Cancers

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An optimal therapeutic strategy for unresectable locally advanced pancreatic cancer (UR-LAPC) has not been established. This study investigated the therapeutic efficacy of chemoradiotherapy (CRT) following induction chemotherapy with gemcitabine plus nab-paclitaxel (GnP) (CRT group) compared with systemic chemotherapy alone (CTx group) in patients with UR-LAPC. This was a retrospective study of 63 consecutive patients with UR-LAPC treated at our department in a Japanese cancer referral center between February 2015 and July 2018. We excluded patients who underwent other regimens and those enrolled in another prospective study. The CRT group (n = 25) exhibited significantly better progression-free survival (PFS) and overall survival (OS) than the CTx group (n = 20, PFS 17.9 vs. 7.6 months, p = 0.044; OS 29.2 vs. 17.4 months, p < 0.001). In the multivariate analyses, CRT following induction chemotherapy was identified as an independent prognostic factor for OS. Seven (15.6%) patients underwent conversion surgery, all of whom were in the CRT group. The R0 resection rate was 85.7% (6/7). In summary, patients with UR-LAPC experienced favorable treatment outcomes after receiving GnP as the first-line chemotherapy, especially when receiving additional CRT. Thus, this treatment strategy represents a promising treatment option for selected patients with UR-LAPC.

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Section: Methodsmentioning

confidence: 99%

The Survival Benefit of Chemoradiotherapy following Induction Chemotherapy with Gemcitabine Plus Nab-Paclitaxel for Unresectable Locally Advanced Pancreatic Cancer

Takada

Ikezawa

Daiku

et al. 2021

Cancers

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“…NAC had a survival benefit in the high-risk group. Takahashi et al 75 classified radiographically R-PDAC with CA19-9 levels of > 120 U/mL as biologically BR-PDAC (bBR-PDAC). Although the survival rate of bBR-PDAC was comparable to that of anatomically BR-PDAC, the prognosis was significantly improved when CA19-9 was normalized by preoperative CRT.…”

Section: Discussionmentioning

confidence: 99%

Development of a Biomarker-Based Scoring System Predicting Early Recurrence of Resectable Pancreatic Duct Adenocarcinoma

et al. 2021

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Background Resectable pancreatic ductal adenocarcinoma (R-PDAC) often recurs early after radical resection, which is associated with poor prognosis. Predicting early recurrence preoperatively is useful for determining the optimal treatment. Patients and methods One hundred and seventy-eight patients diagnosed with R-PDAC on computed tomography (CT) imaging and undergoing radical resection at Hirosaki University Hospital from 2005 to 2019 were retrospectively analyzed. Patients with recurrence within 6 months after resection formed the early recurrence (ER) group, while other patients constituted the non-early recurrence (non-ER) group. Early recurrence prediction score (ERP score) was developed using preoperative parameters. Results ER was observed in 45 patients (25.3%). The ER group had significantly higher preoperative CA19-9 (p = 0.03), serum SPan-1 (p = 0.006), and CT tumor diameter (p = 0.01) compared with the non-ER group. The receiver operating characteristic (ROC) curve analysis identified cutoff values for CA19-9 (133 U/mL), SPan-1 (78.2 U/mL), and preoperative tumor diameter (23 mm). When the parameter exceeded the cutoff level, 1 point was given, and the total score of the three factors was defined as the ERP score. The group with an ERP score of 3 had postoperative recurrence-free survival (RFS) of 5.5 months (95% CI 3.02–7.98). Multivariate analysis for ER-related perioperative and surgical factors identified ERP score of 3 [odds ratio (OR) 4.63 (95% CI 1.82–11.78), p = 0.0013] and R1 resection [OR 3.20 (95% CI 1.01–10.17), p = 0.049] as independent predictors of ER. Conclusions For R-PDAC, ER could be predicted by the scoring system using preoperative serum CA19-9 and SPan-1 levels and CT tumor diameter, which may have great significance in identifying patients with poor prognoses and avoiding unnecessary surgery.

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“…Takahashi et al reported 25% and 34% 5YS in 143 anatomical BRPDAC patients and the 94 resected BRPDAC patients. Moreover, when anatomical RPDAC with pre‐NCRT CA19‐9 level >120 U/mL was defined as biological BRPDAC, prognosis of patients without CA19‐9 normalization was obviously worse (32% 5YS; n = 55), being recognized as anatomical BRPDAC in the NCRT strategy 35 …”

Section: Resectability Criteria and Corresponding Optimal Treatment Smentioning

confidence: 99%

Essential updates 2019/2020: Multimodal treatment of localized pancreatic adenocarcinoma: Current topics and updates in survival outcomes and prognostic factors

Kato

Horiguchi

Ito

et al. 2021

Annals of Gastroent Surgery

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Overall survival of patients with localized pancreatic ductal adenocarcinoma (PDAC) is extremely poor. Therefore, the establishment of multimodal treatment strategies is indispensable for PDAC patients because surgical treatment alone could not contribute to the improvement of survival. In this review article, we focus on the current topics and advancement of the treatments for localized PDAC including resectable, borderline resectable, and locally advanced PDAC in accordance with the articles mainly published from 2019 to 2020. Reviewing the articles, the recent progress of multimodal treatments notably improves the prognosis of patients with localized PDAC. For resectable PDAC, neoadjuvant chemo or chemoradiation therapy, rather than upfront surgery, plays a key role, especially in patients with a large tumor, poor performance status, high tumor marker levels, peripancreatic lymph nodes metastasis, or neural invasion suspected on preoperative imaging. For borderline resectable PDAC, neoadjuvant treatments followed by surgery is a desirable approach, and maintenance of immunonutritional status during the treatments are also important. For locally advanced disease, conversion surgery has a central role in improving a survival outcome; however, its indication should be standardized.

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Clinical implications of the serum CA19-9 level in “biological borderline resectability” and “biological downstaging” in the setting of preoperative chemoradiation therapy for pancreatic cancer

Cited by 31 publications

References 42 publications

The Survival Benefit of Chemoradiotherapy following Induction Chemotherapy with Gemcitabine Plus Nab-Paclitaxel for Unresectable Locally Advanced Pancreatic Cancer

The Survival Benefit of Chemoradiotherapy following Induction Chemotherapy with Gemcitabine Plus Nab-Paclitaxel for Unresectable Locally Advanced Pancreatic Cancer

Development of a Biomarker-Based Scoring System Predicting Early Recurrence of Resectable Pancreatic Duct Adenocarcinoma

Essential updates 2019/2020: Multimodal treatment of localized pancreatic adenocarcinoma: Current topics and updates in survival outcomes and prognostic factors

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