Radiologically occult metastatic pancreatic cancer: how can we avoid unbeneficial resection?

Oba, Atsushi; Inoue, Yosuke; Y, Ono; Irie, Shin; Sato, Takafumi; Mise, Yoshihiro; Ito, Hiromichi; Takahashi, Yu; Saiura, Akio

doi:10.1007/s00423-019-01846-2

Cited by 30 publications

(18 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several reports have been published on the prediction of ER of PDAC and treatment selection based on the prediction. Oba et al 74 defined radiologically occult metastatic pancreatic cancer (ROMPC) as distant metastases revealed during surgery or recurrence within 6 months after surgery. They stated that ROMPC had a significantly lower survival rate than non-ROMPC, and upfront surgery for ROPMC is not beneficial.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Unnecessary resection sometimes hampers truly desirable therapy for patients who have potentially noncurative cancers. 29 Moreover, exclusion of resection after NAT would hasten the next treatment, potentially leading to improved survival. An ultimate goal of patient selection, however, is exclusion of occult metastases (metastatic recurrence), which was not achieved in this series.…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, the significant reduction in non‐therapeutic operations in the GN group reflects the ability of NAT to improve the selection of BR‐PC patients who will really benefit from resection. Unnecessary resection sometimes hampers truly desirable therapy for patients who have potentially noncurative cancers 29 . Moreover, exclusion of resection after NAT would hasten the next treatment, potentially leading to improved survival.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant gemcitabine and nab‐paclitaxel for borderline resectable pancreatic cancers: Intention‐to‐treat analysis compared with upfront surgery

Inoue

Saiura

Oba

et al. 2020

J Hepato Biliary Pancreat

Self Cite

View full text Add to dashboard Cite

Invasive pancreatic cancer (PC) is a devastating disease with only limited patients undergoing curative-intent therapy. Although recent innovations in multidisciplinary treatments have gradually improved survival in resectable PCs, 1,2 the 5-year overall survival (OS) rate of patients with PC remains under 10%. 3 Borderline resectable (BR) PC describes tumors with a high risk of surgical margin positivity after curative-intent resection. 4 A recent consensus on BR-PC treatment recommended neoadjuvant therapy (NAT) followed by resection and adjuvant therapy. 5 This strategy has several theoretical

show abstract

“…Despite remarkable technological advances in medical imaging modalities, approximately 20–50% of patients are found to have metastases at the time of surgery [ 69 , 70 ]. A new definition of radiologically occult pancreatic cancer metastases (ROMPC) has recently been proposed and corresponds to pancreatic cancer with metastases identified during surgery or within 6 months of resection [ 71 ]. Indeed, a nonnegligible rate of patients progress during neoadjuvant therapy or are unresectable during surgery for unknown metastasis, corresponding to the ROMPC situation.…”

Section: Surgical Considerations Following Neoadjuvant Therapy For Rpcmentioning

confidence: 99%

Neoadjuvant Treatment Strategies in Resectable Pancreatic Cancer

Lambert

Schwarz

Ducreux

et al. 2021

Cancers

View full text Add to dashboard Cite

Complete surgical resection is the cornerstone of curative therapy for resectable pancreatic adenocarcinoma. Upfront surgery is the gold standard, but it is rarely curative. Neoadjuvant treatment is a logical option, as it may overcome some of the limitations of adjuvant therapy and has already shown some encouraging results. The main concern regarding neoadjuvant therapy is the risk of disease progression during chemotherapy, meaning the opportunity to undergo the intended curative surgery is missed. We reviewed all recent literature in the following areas: major surveys, retrospective studies, meta-analyses, and randomized trials. We then selected the ongoing trials that we believe are of interest in this field and report here the results of a comprehensive review of the literature. Meta-analyses and randomized trials suggest that neoadjuvant treatment has a positive effect. However, no study to date can be considered practice changing. We considered design, endpoints, inclusion criteria and results of available randomized trials. Neoadjuvant treatment appears to be at least a feasible strategy for patients with resectable pancreatic cancer.

show abstract

Radiologically occult metastatic pancreatic cancer: how can we avoid unbeneficial resection?

Cited by 30 publications

References 24 publications

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

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

Neoadjuvant gemcitabine and nab‐paclitaxel for borderline resectable pancreatic cancers: Intention‐to‐treat analysis compared with upfront surgery

Neoadjuvant Treatment Strategies in Resectable Pancreatic Cancer

Contact Info

Product

Resources

About