Conditional Survival in Resected Pancreatic Ductal Adenocarcinoma Patients Treated with Total Neoadjuvant Therapy

Michelakos, Theodoros; Sekigami, Yurie; Kontos, Filippos; Castillo, C. Fernandez-del; Qadan, Motaz; Ting, David T.; Clark, Jeffrey W.; Weekes, Colin D.; Parikh, Aparna; Ryan, David P.; Wo, Jennifer Y.; Hong, Theodore S.; Allen, Jill N.; Catalano, Onofrio A.; Warshaw, Andrew L.; Lillemoe, Keith D.; Ferrone, Cristina R.

doi:10.1007/s11605-020-04897-9

Cited by 8 publications

(15 citation statements)

References 24 publications

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“…More precisely, more than 75% of tumor recurrences developed within the first 2 years after surgery, and the probability of recurrence within the next 1 year after a given RFS time started decreasing after 2yRFS and significantly lowered after 3yRFS. These findings are in line with previous reports 5,12 . Groot et al reported that 79.5% of patients who received upfront surgery for PC experienced recurrence within 24 months after surgery 5 .…”

Section: Discussionsupporting

confidence: 92%

“…9,10 CS analyses after surgical resection have been attempted in patients with various malignancies, including PC. 2,[12][13][14][15][16] Malleo et al published a CS analysis after upfront surgery for PC that described in detail how the probability of death related to PC and how the significance of the prognostic variables evolves over time after surgery. 13 The concept of CS has been further extended, with some researchers analyzing the risk of tumor recurrence in a conditional manner (ie, conditional recurrence-free survival: C-RFS) in the resection of some gastrointestinal malignancies.…”

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confidence: 99%

“…CS is a statistical concept based on conditional risk calculation and represents the probability of surviving an additional length of time in the subgroup of patients who have already survived a given amount of time after surgery 9,10 . CS analyses after surgical resection have been attempted in patients with various malignancies, including PC 2,12–16 . Malleo et al published a CS analysis after upfront surgery for PC that described in detail how the probability of death related to PC and how the significance of the prognostic variables evolves over time after surgery 13 .…”

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confidence: 99%

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Pathological Nodal and Vascular Involvement Significantly Impacts the Recurrence Risk in Different Time Frames in Patients With Resectable and Borderline Resectable Pancreatic Cancer

et al. 2023

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Objective: To investigate the long-term dynamics of recurrence risk and the significance of prognostic variables using conditional recurrence-free survival (C-RFS) analysis in neoadjuvant treatment (NAT) for resectable (R) and borderline resectable (BR) pancreatic cancer (PC). Background: C-RFS analysis assesses the probability of achieving additional RFS according to the RFS already accrued. Methods: Patients with NAT and subsequent resection for R/BRPC were enrolled. In the C-RFS analysis, the actual 5-year RFS (5yRFS) rate was calculated separately in the subgroup that had already gained a given amount of RFS. The significance levels of prognostic variables associated with 5yRFS were assessed regarding their time-dependent dynamics in a conditional fashion. Results: Among the total 397 patients, 160 survived for more than 5 years without recurrence after surgery (actual 5yRFS rate: 45%). The probability of 5yRFS incrementally increased based on the RFS already accrued. Pathological nodal and vascular involvement were significant influencers of 5yRFS. The patients with nodal involvement consistently remained at significantly higher risk of recurrence than those without, even after 5yRFS, whereas positivity of vascular involvement was significantly associated with the risk of recurrence only during the early postoperative period and lost its significance after 3yRFS accrued. Conclusions: In NAT for R/BRPC, the probability of gaining additional RFS increases as a function of RFS already accrued, and the significance of prognostic variables time-dependently evolves in their own patterns during the long-term postoperative period.

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Section: Discussionsupporting

confidence: 92%

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confidence: 99%

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confidence: 99%

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Pathological Nodal and Vascular Involvement Significantly Impacts the Recurrence Risk in Different Time Frames in Patients With Resectable and Borderline Resectable Pancreatic Cancer

et al. 2023

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“…1 Massachusetts General Hospital, Boston, MA 2 National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 3 Thomas Jefferson University, Philadelphia, PA 4 Johns Hopkins University School of Medicine, Baltimore, MD 5 New York University, New York, NY 6 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 7 Northwell Health Cancer Institute, Zucker School of Medicine, Manhasset, NY…”

Section: Affiliationsmentioning

confidence: 99%

“…1 Although significant advances have been made in the efficacy of chemotherapeutics for the disease, surgical resection remains the only treatment that provides patients the possibility of long-term survival. 2 However, surgical resection is associated with significant morbidity that can decondition patients and often lead to significant weight loss for several months postoperatively. 3,4 Additionally, any pancreatic resection has a significant impact on patients' quality of life.…”

Section: Introductionmentioning

confidence: 99%

Profile of the Postoperative Care Provided for Patients With Pancreatic and Periampullary Cancers by Family and Unpaid Caregivers

Fong

Teinor

Yeo

et al. 2023

JCO Oncology Practice

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PURPOSE Patients with pancreatic and periampullary cancers may experience significant reduction in their quality of life and often rely on family and unpaid caregivers for assistance after surgery. However, as caregivers are not systematically identified, little is known about the nature, difficulty, and personal demands of assistance they provide. We aim to assess the frequency and difficulty of specific assistance caregivers provide and identify potential interventions that could alleviate the caregiving demands. METHODS This was a prospective, multi-institutional study of caregivers accompanying patients with periampullary and pancreatic cancer at their 1-month postpancreatectomy office visit. An instrument that drew heavily on the National Study of Caregiving was administered to caregivers. RESULTS Of 240 caregivers, more than half (58.3%) of caregivers were the patients' spouse, a quarter (25.8%) were daughters or sons, 12.9% other relatives, and 2.9% nonrelatives. Caregivers least frequently provided assistance with transportation (14.6% every day) and most frequently provided assistance with housework (65.0% every day, P = .003) and diet (56.5% every day, P = .004). Caregivers reported the least difficulty helping patients with exercise (1.5% somewhat difficult). Caregivers reported significantly more difficulty with assisting with housework (14.5% somewhat difficult, P < .001) and diet (14.9% somewhat difficult, P < .001). Caregivers identified the immediate postpancreatectomy and early discharge periods as the most stressful phases. They also reported having received very little information about available services that could have supported their efforts. CONCLUSION Caregivers of patients with periampullary or pancreatic cancer provide considerable assistance in the postoperative period and many reported difficulty in assisting with housework and diet. Work is needed to better prepare and support caregivers to better enable them to adequately care for patients with pancreas and periampullary cancer.

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Total neoadjuvant therapy improves survival of patients with borderline resectable pancreatic cancer with arterial involvement

Akahori

Terai

Nagai

et al. 2023

Annals of Gastroent Surgery

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AimThis study aimed to evaluate the prognostic impact of total neoadjuvant therapy (TNT) for borderline resectable pancreatic cancer with arterial involvement (BR‐A) pancreatic cancer.MethodsWe analyzed 81 patients initially diagnosed as BR‐A who received initial treatments between 2007 and 2021. Among them, 18 patients who received upfront surgery were classified as the UFS group, while 30 patients who were treated with neoadjuvant chemoradiotherapy were classified as the NACRT group. Furthermore, 33 patients who planned to receive a combination treatment of over 6 months of systemic chemotherapies followed by chemoradiotherapy before surgery were classified as the TNT group.ResultsThere were no significant differences in the patients’ backgrounds between the three groups at the time of initial treatment. The resection rates of the UFS, NACRT, and TNT groups were 89%, 77%, and 67%, respectively. NACRT had no impact on the prognosis compared to upfront surgery. In sharp contrast, the TNT group had a significantly better prognosis compared to the other groups, especially after pancreatic resection. Multivariate analysis demonstrated that TNT and resection were independent prognostic factors for the patients of BR‐A.ConclusionTNT can be a promising therapeutic strategy for patients with BR‐A.

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Conditional Survival in Resected Pancreatic Ductal Adenocarcinoma Patients Treated with Total Neoadjuvant Therapy

Cited by 8 publications

References 24 publications

Pathological Nodal and Vascular Involvement Significantly Impacts the Recurrence Risk in Different Time Frames in Patients With Resectable and Borderline Resectable Pancreatic Cancer

Pathological Nodal and Vascular Involvement Significantly Impacts the Recurrence Risk in Different Time Frames in Patients With Resectable and Borderline Resectable Pancreatic Cancer

Profile of the Postoperative Care Provided for Patients With Pancreatic and Periampullary Cancers by Family and Unpaid Caregivers

Total neoadjuvant therapy improves survival of patients with borderline resectable pancreatic cancer with arterial involvement

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