PMID- 32947122
OWN - NLM
STAT- MEDLINE
DCOM- 20210104
LR  - 20210104
IS  - 1095-8673 (Electronic)
IS  - 0022-4804 (Linking)
VI  - 257
DP  - 2021 Jan
TI  - Temporal Assessment of Prognostic Factors in Patients With Pancreatic Ductal 
      Adenocarcinoma Undergoing Neoadjuvant Treatment and Resection.
PG  - 605-615
LID - S0022-4804(20)30536-9 [pii]
LID - 10.1016/j.jss.2020.07.073 [doi]
AB  - BACKGROUND: The clinicopathologic factors associated with the survival of 
      patients with pancreatic ductal adenocarcinoma (PDAC) during the different phases 
      of neoadjuvant treatment (NT)-at diagnosis, restaging, or postoperatively-remain 
      unclear. METHODS: Data of patients with PDAC who underwent pancreatic resection 
      after NT between 2008 and 2018 were retrospectively collected. Clinicopathologic 
      characteristics and outcomes were compared stratified by resection margin status. 
      Three multivariable regression models (at diagnosis, restaging, and 
      postoperatively) were constructed to assess the temporal impact of different 
      prognostic factors on all-cause survival (ACS) and disease-free survival (DFS). 
      RESULTS: All patients were diagnosed with a nonmetastatic PDAC and were 
      appropriate candidates for NT according to the current National Comprehensive 
      Cancer Network guidelines. From a total of 83 patients, 57 (68.7%) had a negative 
      resection margin >1 mm (R0), whereas 26 patients (31.3%) had a positive resection 
      margin (R1). At diagnosis, planned procedure (P = 0.017) and CA19-9 >100 U/mL 
      (P = 0.047) were independent prognostic factors of decreased ACS. At restaging, 
      planned procedure (P = 0.017), FOLFIRINOX (P = 0.026), and tumor size >30 mm 
      (P = 0.030) were independent prognostic factors for increased and decreased ACS, 
      respectively. Postoperatively, R0 was an independent prognostic factor for 
      improved ACS (P = 0.005) and DFS (P = 0.002), whereas adjuvant therapy 
      (P = 0.006) was associated with increased ACS. Lymph node involvement (P = 0.019) 
      was associated with decreased DFS. CONCLUSIONS: At diagnosis, restaging, and 
      postoperatively, different, relevant clinicopathologic factors significantly 
      impact the survival of patients with nonmetastatic PDAC undergoing NT. An R0 
      resection remains the most important prognostic factor and therefore should be 
      the primary goal of surgical treatment in the neoadjuvant setting.
CI  - Copyright (c) 2020. Published by Elsevier Inc.
FAU - Ren, Weizheng
AU  - Ren W
AD  - Department of Hepatopancreatobiliary Surgery, First Center of General Hospital of 
      People's Liberation Army, Beijing, China; Department of Surgery, Brigham and 
      Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, 
      Massachusetts.
FAU - Xourafas, Dimitrios
AU  - Xourafas D
AD  - Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; 
      Harvard Medical School, Boston, Massachusetts.
FAU - Ashley, Stanley W
AU  - Ashley SW
AD  - Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; 
      Harvard Medical School, Boston, Massachusetts.
FAU - Clancy, Thomas E
AU  - Clancy TE
AD  - Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; 
      Harvard Medical School, Boston, Massachusetts. Electronic address: 
      tclancy@bwh.harvard.edu.
LA  - eng
PT  - Journal Article
DEP - 20200915
PL  - United States
TA  - J Surg Res
JT  - The Journal of surgical research
JID - 0376340
SB  - IM
MH  - Aged
MH  - Boston/epidemiology
MH  - Carcinoma, Pancreatic Ductal/*mortality/pathology/therapy
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Neoadjuvant Therapy
MH  - Pancreas/pathology
MH  - *Pancreatectomy
MH  - Pancreatic Neoplasms/*mortality/pathology/therapy
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Margin negative resection
OT  - Neoadjuvant treatment
OT  - Pancreatic ductal adenocarcinoma
OT  - Prognostic factor
EDAT- 2020/09/19 06:00
MHDA- 2021/01/05 06:00
CRDT- 2020/09/18 20:16
PHST- 2020/03/09 00:00 [received]
PHST- 2020/06/18 00:00 [revised]
PHST- 2020/07/03 00:00 [accepted]
PHST- 2020/09/19 06:00 [pubmed]
PHST- 2021/01/05 06:00 [medline]
PHST- 2020/09/18 20:16 [entrez]
AID - S0022-4804(20)30536-9 [pii]
AID - 10.1016/j.jss.2020.07.073 [doi]
PST - ppublish
SO  - J Surg Res. 2021 Jan;257:605-615. doi: 10.1016/j.jss.2020.07.073. Epub 2020 Sep 
      15.