Ann Hepatobiliary Pancreat Surg.  2022 Nov;26(4):363-374. 10.14701/ahbps.22-023.

Neoadjuvant therapy impact in early pancreatic cancer: “bioborderline” vs. “non-bioborderline”

• Taboada AGM
• Lominchar PL
• Martínez MF
• García-Alfonso P
• Martin AM
• Asencio JM

• KMID: 2536387
• DOI: http://doi.org/10.14701/ahbps.22-023

Abstract

Backgrounds/Aims
To analyze the results of the neoadjuvant treatment of patients in our center with early pancreatic cancer.
Methods
Eighty-four patients with early pancreatic cancer (I–II) were included, of which 59 were considered “bioborderline” (carbohydrate antigen [CA] 19-9 > 37 U/L), and 25 were considered “non-bioborderline” (CA19-9 < 37 U/L). The R0 resection rate, presence of negative nodes, survival, and recurrence rates were analyzed in two groups, the NEO group (neoadjuvant + surgery) and the nonNEO group (upfront surgery).
Results
A 28.6% pathologic complete response was observed in the NEO group of the whole sample. The residual R0 was 85.7%, and nodes were negative in 78.6% of the patients in the NEO group of bioborderline patients. All non-bioborderline patients treated with neoadjuvant were R0, and no affected nodes were observed in any of them. The median overall survival (OS) in patients with elevated CA19-9 levels in the NEO group was 31.4 months vs. 13.1 months in the non-NEO (log-rank test p = 0.006), with a 62% relative reduction in the mortality rate (hazard ratio = 0.38, 95% confidence interval: 0.20–0.79; p = 0.008). The median OS in patients with normal CA19-9 levels in the NEO group was 65.9 months vs. 16.2 months in the non-NEO group, without statistically significant differences between the two but with a trend toward significance (log-rank test p = 0.08).
Conclusions
A neoadjuvant strategy seemed to improve local control and the survival of patients with early pancreatic cancer, both those with elevated CA19-9 and normal marker levels.

Keyword

Pancreatic neoplasms; Neoadjuvant therapy; Biomarkers; Early pancreatic cancer

Figure

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  Fig. 1 Flowchart of the groups analyzed. NEO group: neoadjuvant + surgery; non-NEO group: upfront surgery. CA19-9, carbohyd rate antigen 19-9.

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  Fig. 2 Comparison of overall survival between groups “Bioborderline vs. Non-bioborderline”.

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  Fig. 3 Overall survival of Bioborderline “NEO vs. Non-NEO”. NEO, Neoadjuvant group; Non-NEO, non-neoadjuvant group.

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  Fig. 4 Overall survival of Non-bioborderline “NEO vs. Non-NEO”. NEO, neoadjuvant group; Non-NEO, non-neoadjuvant group.

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