Is it justified to assess the resectability of pancreatic cancer combined with biological and conditional factors?

Bingying Huang; Hao Geng; Yun Jin; Xiaoxiao Zhang; Hai Qian; Dan Ye; Jinhong Wu; Huanbing Zhu; Yuanquan Yu; Donger Zhou; Jiangtao Li

doi:10.21037/tcr-22-1258

Is it justified to assess the resectability of pancreatic cancer combined with biological and conditional factors?

Transl Cancer Res. 2022 Oct;11(10):3458-3470. doi: 10.21037/tcr-22-1258.

Authors

Bingying Huang^#¹, Hao Geng^#², Yun Jin², Xiaoxiao Zhang², Hai Qian², Dan Ye², Jinhong Wu², Huanbing Zhu², Yuanquan Yu², Donger Zhou², Jiangtao Li²

Affiliations

¹ Department of Nursing, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
² Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.

^# Contributed equally.

Abstract

Background: This study aimed to investigate the biological and conditional resectability criteria for pancreatic ductal adenocarcinoma (PDAC), as proposed by the International Association of Pancreatology (IAP), as well as to identify the role of biological and conditional factors in assessing the resectability of PDAC.

Methods: The clinical data of PDAC patients who underwent upfront open/laparoscopic pancreaticoduodenectomy (PD/LPD) or distal pancreatectomy (DP/LDP) at our hospital between January 2013 to June 2019 were retrospectively analyzed. Patients who were diagnosed with anatomically resectable PDAC, as defined by National Comprehensive Cancer Network (NCCN) guideline of PDAC guideline Version 1.2020, were enrolled. Based on IAP-criteria, these patients were divided into two groups, including IAP-resectable (IAP-R) and IAP Borderline Resectable (IAP-BR). Clinical characteristics and outcomes were compared between the two groups. In order to identify independent biological and conditional predictors of recurrence-free survival (RFS) and overall survival (OS) of enrolled patients, an analysis was performed through the use of a Cox proportional-hazard model.

Results: Overall, 97 patients were included in this study. Among them, 38 patients were IAP-R and 59 patients were IAP-BR. Compared to the IAP-R group, the IAP-BR group had a higher early recurrence rate (62.7% vs. 42.1%; P=0.047), and the median RFS (9.2 vs. 18.3 months, P<0.01) and OS (19.1 vs. 30.6 months, P<0.05) were also significantly worse. Preoperative CA19-9 serum levels that exceeded 500 U/mL and/or an imaging diagnosis of regional lymph nodes metastasis were independently associated with OS and RFS of anatomically resectable PDAC.

Conclusions: The prognosis of patients with PDAC that undergo resection can be predicted more accurately by assessing the resectability of pancreatic cancer combined with anatomical and biological factors according to IAP criteria. Whether conditional factors should be included in the resectability criteria needs to be validated by prospective and large cohorts.

Keywords: Pancreatic cancer; biological factors; conditional factors; prognosis; resectability.