Introduction

Neoadjuvant treatment for resectable pancreatic cancer (R-PC) is expected to decrease the postoperative recurrence and prolong the survival. However, It remains unclear whether NAC is necessary for all patients.

Aims & Methods

The present study investigated the prognostic factors associated with actual five-year recurrence-free survival (RFS) after upfront surgery for R-PC in patients who were deemed not to require neoadjuvant treatment. Between 2007 and 2016, 316 patients who underwent pancreatectomy for radiologically R-PC were retrospectively reviewed to evaluate the predictors of actual 5-year RFS. Predictors were identified using logistic regression analysis of preoperative evaluable factors. The cutoff values for continuous variables were determined based on a minimum P-value approach (model 1) or the value that maximized the rate of five-year RFS survivors (model 2).

Results

Fifty-one patients (16.1%) achieved a 5-year RFS. A tumor size ≤23 mm, absence of serosal invasion on computed tomography (CT), and neutrophil-to-lymphocyte ratio (NLR) <1.0, were significantly associated with the 5-year RFS in model 1. A prognostic nutritional index (PNI) ≥58 and the absence of serosal invasion and extrapancreatic nerve plexus invasion on CT were significantly associated with 5-year RFS in model 2. Only six (11.8%, model 1) and four (7.8%, model 2) patients had all three prognostic factors, and their 5-year RFS rates were 83.3% and 100%, respectively.

Conclusion

A modest number of patients who underwent upfront surgery achieved 5-year RFS, but only approximately 10% of them could be identified preoperatively. Based on these results, almost all R-PC patients are forced to undergo NAT in daily practice.

Introduction

The prognostic significance of the preoperative C-reactive protein-albumin-lymphocyte (CALLY) index has been reported in various cancer types; however, its role in pancreatic cancer remains unclear.

Aims & Methods

A cohort of 339 patients with resectable pancreatic cancer (RPC) who underwent curative surgery between July 2012 and December 2019 was analyzed. The CALLY　index was defined as (albumin × lymphocytes)/ (C-reactive protein × 10⁴). The cutoff value of the CALLY index was determined according to　receiver operating characteristics analysis using survival status　at the 3-year　follow-up. 　We investigated the association　 between the CALLY index with disease-free survival (DFS) and overall survival (OS) using univariate and multivariate analyses.

Results

The median CALLY index was 4.1, with an interquartile range of 1.4–11.7. The cutoff value of the CALLY index was set at 3.0, dividing the patients into the CALLY-high group (> 3.0; n = 198) and the CALLY-low group (≤ 3.0; n = 141). The DFS and OS in the CALLY-low group were significantly worse than those in the CALLY-high group (p < 0.001 and p < 0.001, respectively). Multivariate analysis, using the preoperative clinicopathological variables, indicated that the CALLY index ≤ 3.0 was an independent prognostic factor for DFS (Hazard Ratio [HR] 1.53, p = 0.008) and for OS (HR 1.69, p = 0.002).

Conclusion

In RPC, survival outcomes were significantly stratified by the CALLY index = 3.0, with < 3 being a significantly poor prognostic factor for DFS and OS. The CALLY index may be useful in predicting the long-term survival of patients with RPC.

Introduction

Advanced pancreatic cancer (PC) continues to be associated with a poor prognosis, where the occurrence of pancreatic exocrine insufficiency frequently leads to malnutrition and deteriorating nutritional status. Traditional laboratory markers, such as lymphocyte count and serum albumin levels, are commonly employed to assess nutritional status; however, integrated nutritional indices like the Prognostic Nutritional Index (PNI) have emerged as significant prognostic indicators in various malignancies. Notably, a low PNI has been identified as a predictor of postoperative complications following the Whipple procedure in pancreatic cancer patients and significantly correlates with overall survival among individuals with advanced PC. While the Nutritional Risk Index (NRI) has been evaluated in other cancer types, its application in advanced pancreatic cancer remains underexplored.

Aims & Methods

This study aims to evaluate the prognostic value of PNI and NRI in patients with advanced pancreatic cancer.
A retrospective analysis was conducted on electronic medical records of 158 patients diagnosed with advanced pancreatic cancer who were initiating chemotherapy. PNI and NRI were computed using standard parameters, and baseline levels were compared between patients with proximal and distal tumor locations. Among 125 patients commencing FOLFIRINOX chemotherapy, baseline PNI and NRI were analyzed in relation to outcomes at the 12-week follow-up, categorizing patients into groups based on mortality (n=21), disease progression (n=51), and disease stabilization (n=53). Statistical differences between high and low nutritional index groups were assessed using the log-rank test, and both univariate and multivariable analyses were conducted to identify risk factors associated with mortality within three months post-chemotherapy initiation.

Results

The analysis revealed that patients with tumors located in the pancreatic head exhibited significantly lower PNI (40.11 vs. 42.01, p=0.002) and NRI (104.30 vs. 110.06, p=0.004) compared to those with distal tumors. In the FOLFIRINOX subgroup, a significant decrease in PNI (39.51 vs. 41.51 and 41.82, p=0.044) was observed among those who deceased by the first follow-up, while NRI did not show similar significance. Univariate analysis identified a PNI cut-off of 40.25 (HR 2.514; 95% CI: 1.025-6.169, p=0.044) and an NRI threshold below 105.6 (HR 2.75; 95% CI: 1.039-7.277, p=0.042) as independent prognostic factors. However, in multivariable analysis, the presence of two or more metastatic sites beyond the primary tumor was the only factor significantly related to mortality risk by the follow-up (HR 7.21; 95% CI: 2.02-25.738, p=0.002).

Conclusion

Our findings underscore the relationship between PNI and NRI with nutritional status, asserting their utility as predictive tools for survival in patients with advanced pancreatic cancer initiating chemotherapy.

Introduction

Aims & Methods

The aim of the current study was to investigate trends in survival and treatment patterns by analyzing German health claims data.
Pancreatic cancer patients diagnosed between 2010 and 2017 were identified from the German Pharmacoepidemiological Research Database (GePaRD, approximately 20% of the German population). Data on demographics, tumor treatment within one year after diagnosis and survival were extracted.

Results

The study population comprised 23,339 patients with a median age of 74 years (IQR 66-80) and 44% with localized and 56% with metastatic disease. Overall, 52.4% received any chemotherapy and curative intended resection was performed in 28.3%. Neoadjuvant and adjuvant therapy were performed in 4.4% and 58.7% of the cases, respectively. The median overall survival of the whole study population was 7.84 months.
Patients diagnosed in the most recent period (2014-2017) had a significantly better prognosis (8.20 months (95%CI 7.97-8.43)) than patients who were diagnosed in the earlier period (2010-2013) (7.54 months (95%CI 7.31-7.70)), with an age-, sex- and stage-adjusted hazard ratio of 0.87 (95% CI 0.85-0.9). Over time, the most pronounced treatment trends have affected patients with localized disease, with increasing frequency of resection and neoadjuvant therapy and decreasing frequency of best supportive care.

Conclusion

This comprehensive insight into survival and treatment of pancreatic cancer in Germany shows presumably medically beneficial therapy trends with, however, only marginal improvements in prognosis to date.

Introduction

The benefits of neoadjuvant therapy for patients with pancreatic cancer (PC) with portal venous involvement are still a matter of debate. The aim of this study is to compare the short- and long-term outcomes of surgery with or without neoadjuvant therapy (NAT) in patients with PC with suspicion of venous involvement.

Aims & Methods

A multicenter retrospective cohort study was conducted to compare patients who underwent upfront surgery (US) vs patients who underwent surgery after NAT for PC with suspicion of venous involvement between 2007 and 2017. The primary endpoints were short-term morbidity and mortality, overall survival and disease-free survival.

Results

We included 690 patients who underwent US and 361 patients with NAT from 9 centers. Patients with NAT had more suspicion of radiological SMV-PV involvement(83.6% vs 96.9%, p<0.001), but received fewer SMV-PV resections (79.3% vs 53.7%, p<0.001) and in the final pathology had less SMV-PV infiltration (65.9% vs 52.3%, p<0.001), perineural invasion (90.1% vs 75.2%, p<0.001), angioinvasion (76.7% vs 59.9%, p<0.001), lymph node involvement (83.6% vs 60.6%, p<0.001) and R1 resections (67.2% vs 44.7%, p<0.001). In patients undergoing venous resection, there were no differences between the US and NAT patients in major postoperative complications (20.0% vs 22.8%, p<0.50) and reoperations (10.2% vs 11.4%, p<0,66). When venous resection was not performed, patients with NAT had significantly fewer (Clavien-Dindo ≥IIIb) postoperative complications (24.4% vs 10.8%, p=0.02), fewer reoperations (11.2% vs 3.0%, p=0.006), and less 90-day mortality (7.7% vs 2.4%, p=0.03). Furthermore, patients with NAT had a significantly better survival of 27.3 compared to 21.2 months in patients with US (p = 0.003).

Table 3. Short-term morbidity and mortality

Conclusion

NAT should be considered in patients with PC with venous involvement, since it might allow a better selection of patients and is associated with less degree of major postoperative complications and better overall survival.

Introduction

Pancreatic cancer is a fatal disease with a poor prognosis. Even after curative surgery, the overall survival (OS) is low, owing to the high frequency of relapses or surgical complications. Neoadjuvant chemotherapy (NAC) has recently been reported to improve OS; however, early postoperative death has been reported in some cases. Conversely, chemotherapy for unresectable pancreatic cancer is progressing; the median OS has been extended to approximately 15 months. Therefore, it is necessary that we carefully consider the possibility of surgery including NAC. There are many reports based on postoperative staging; however, there are few reports about preoperative prognostic factors in pancreatic cancer. This study aimed to evaluate these factors in patients with operable pancreatic cancer.

Aims & Methods

Between April 2010 and March 2023, 284 patients were diagnosed with resectable (R) or borderline resectable (BR) pancreatic cancer at the Sendai Kousei Hospital. Sixteen patients who were diagnosed with unresectable cancer after NAC were excluded. The preoperative clinical factors and OS were retrospectively evaluated. Survival data were compared using the log-rank test. P-value <0.05 was considered statistically significant. Clinical factors included in the univariate analyses were as follows: age (<75 years vs. ≧75 years), sex, region (head vs. body and tail), resectability (R vs. BR), CA19-9 (<37.0 U/ml vs. ≧37.0 U/ml), preoperative chemotherapy (upfront surgery vs. NAC), and staging (evaluated using computed tomography). Clinical staging was determined using preoperative TNM classification based on the General Rules for the Study of Pancreatic Cancer in Japan (8^th Edition). Multivariate analysis was performed using a Cox proportional hazards regression model.

Results

The median follow-up period for OS analysis was 30.6 months. Among the clinical parameters, lymph node metastasis (clinical N1; cN1), tumor extent (cT3 or T4), and CA19-9 (≧37.0 U/ml) were significant predictors for OS in the univariate analysis. The median OS of the upfront surgery group (n=214) and the NAC group (n=54) were 28.7 and 39.7 month, respectively, showing an increase of approximately 11 months, which was not significant (p=0.33). Multivariate analysis revealed that only lymph node metastasis (cN1) remained an independent OS predictor (Hazard Ratio, 2.004; 95%CI 1.453-2.875; p<0.001). Median OS was 39.7 and 12.9 months in the cN0 (n=204) and cN1 groups (n=64) (p<0.001), respectively. The survival rate at three years were 51.8% and 21.3% in the cN0 and cN1 groups, respectively.

Conclusion

Preoperative lymph node metastasis was the strongest prognostic factor in patients with resectable or borderline resectable pancreatic cancer.