Validation of the Anatomical and Biological Definitions of Borderline Resectable Pancreatic Cancer According to the 2017 International Consensus for Survival and Recurrence in Patients with Pancreatic Ductal Adenocarcinoma Undergoing Upfront Surgery

Lee, Boram; Yoon, Yoo‐Seok; Kang, MeeYoung; Park, Yeshong; Lee, Eun‐Hye; JO, Yeongsoo; Lee, Jun Suh; Lee, Hae Won; Cho, Jai Young; Han, Ho‐Seong

doi:10.1245/s10434-022-13043-5

Cited by 8 publications

(3 citation statements)

References 28 publications

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“…Patients were classified as PR, BR-A (anatomic BR disease), BR-B (PR disease and CA 19-9 >500), or BR-AB (BR disease and CA 19-9 >500). 30 They found that the BR-B group not only had a higher R0 resection rate compared with the BR-A group (BR-A: 72.1% v BR-B: 82.7) but also a higher rate of early recurrence (BR-A: 60.5% v BR-B: 70.4%). Anger et al, classified 345 patients, all of whom underwent surgery as primary therapy, as PR, BR-A, or BR-B (CA 19-9 >500).…”

Section: Discussionmentioning

confidence: 97%

“…29 Several smaller retrospective series have evaluated the prognostic value of the ABC factors. [30][31][32] A recent study investigated 404 patients with PR and BR PDAC, who all underwent surgery as primary therapy. Patients were classified as PR, BR-A (anatomic BR disease), BR-B (PR disease and CA 19-9 >500), or BR-AB (BR disease and CA 19-9 >500).…”

Section: Discussionmentioning

confidence: 99%

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Improved Clinical Staging System for Localized Pancreatic Cancer Using the ABC Factors: A TAPS Consortium Study

Dekker,

van Dam,

Janssen

et al. 2024

JCO

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PURPOSE Previous studies suggest that besides anatomy (A: resectable, borderline resectable [BR], or locally advanced [LA]) also biologic (B: carbohydrate antigen 19-9 [CA 19-9]) and conditional (C: performance status) factors should be considered when staging patients with localized pancreatic ductal adenocarcinoma (PDAC). The prognostic value of the combined ABC factors has not been quantitatively validated. METHODS In this retrospective cohort study, we evaluated patients with localized PDAC treated with initial (modified) fluorouracil with leucovorin, irinotecan, and oxaliplatin ([m]FOLFIRINOX) at five high-volume pancreatic cancer centers in the United States and the Netherlands (2012-2019). Multivariable Cox proportional hazards analysis was used to investigate the impact of the ABC factors for overall survival (OS). RESULTS Overall, 1,835 patients with localized PDAC were included. Tumor stage at diagnosis was potentially resectable in 346 (18.9%), BR in 531 (28.9%), and LA in 958 (52.2%) patients. The baseline CA 19-9 was >500 U/mL in 559 patients (32.5%). Performance status was ≥1 in 1,110 patients (60.7%). Independent poor prognostic factors for OS were BR disease (hazard ratio [HR], 1.26 [95% CI, 1.06 to 1.50]), LA disease (HR, 1.71 [95% CI, 1.45 to 2.02]), CA 19-9 >500 U/mL (HR, 1.36 [95% CI, 1.21 to 1.52]), and WHO performance status ≥1 (HR, 1.31 [95% CI, 1.16 to 1.47]). Patients were assigned 1 point for each poor ABC factor and 2 points for LA disease. The median OS for patients with score 0-4 was 49.7, 29.9, 22.0, 19.1, and 14.9 months with corresponding 5-year OS rates of 47.0%, 28.9%, 19.2%, 9.3%, and 4.8%, respectively. CONCLUSION The ABC factors of tumor anatomy, CA 19-9, and performance status at diagnosis were independent prognostic factors for OS in patients with localized PDAC treated with initial (m)FOLFIRINOX. Staging of patients with localized PDAC at diagnosis should be based on anatomy, CA 19-9, and performance status.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Improved Clinical Staging System for Localized Pancreatic Cancer Using the ABC Factors: A TAPS Consortium Study

Dekker,

van Dam,

Janssen

et al. 2024

JCO

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“…Lee and coauthors-in this elegant work-validate the ICC 2017 definition of borderline resectable PDAC using a single-institutional retrospective cohort study design. 8 The authors describe their experience with a surgery-first approach for PDAC, during a period characterized by a gradual but profound change in systemic chemotherapy strategies (2004-2020). Of the 404 patients who underwent surgery, the majority had resectable disease (R, N = 259), serving as the control group to which the authors compared all other outcomes related to the treatment of BR disease.…”

mentioning

confidence: 99%

Editorial on: Moving Beyond Anatomic Criteria for Resectability: Validation of the Anatomical and Biological Definitions of Borderline Resectable Pancreatic Cancer According to the 2017 International Consensus for Survival and Recurrence in Patients with Pancreatic Ductal Adenocarcinoma Undergoing Upfront Surgery

Paniccia

Zureikat

2023

Ann Surg Oncol

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Current clinical practice in the management of Brazilian patients with potentially resectable pancreatic ductal adenocarcinoma (PDAC)

de Jesus,

Peixoto,

Ribeiro

et al. 2023

Journal of Surgical Oncology

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Background and ObjectivesWe aimed to describe the routine clinical practice of physicians involved in the treatment of patients with localized pancreatic ductal adenocarcinoma (PDAC) in Brazil.MethodsPhysicians were invited through email and text messages to participate in an electronic survey sponsored by the Brazilian Gastrointestinal Tumor Group (GTG) and the Brazilian Society of Surgical Oncology (SBCO). We evaluated the relationship between variable categories numerically with false discovery rate‐adjusted Fisher's exact test p values and graphically with Multiple Correspondence Analysis.ResultsOverall, 255 physicians answered the survey. Most (52.5%) were medical oncologists, treated patients predominantly in the private setting (71.0%), and had access to multidisciplinary tumor boards (MTDTB; 76.1%). Medical oncologists were more likely to describe neoadjuvant therapy as beneficial in the resectable setting and surgeons in the borderline resectable setting. Most physicians would use information on risk factors for early recurrence, frailty, and type of surgery to decide treatment strategy. Doctors working predominantly in public institutions were less likely to have access to MTDTB and to consider FOLFIRINOX the most adequate regimen in the neoadjuvant setting.ConclusionsConsiderable differences exist in the management of localized PDAC, some of them possibly explained by the medical specialty, but also by the funding source of health care.

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Validation of the Anatomical and Biological Definitions of Borderline Resectable Pancreatic Cancer According to the 2017 International Consensus for Survival and Recurrence in Patients with Pancreatic Ductal Adenocarcinoma Undergoing Upfront Surgery

Cited by 8 publications

References 28 publications

Improved Clinical Staging System for Localized Pancreatic Cancer Using the ABC Factors: A TAPS Consortium Study

Improved Clinical Staging System for Localized Pancreatic Cancer Using the ABC Factors: A TAPS Consortium Study

Current clinical practice in the management of Brazilian patients with potentially resectable pancreatic ductal adenocarcinoma (PDAC)

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