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Risk Stratification of Pancreatic Ductal Adenocarcinoma Patients Undergoing Curative-Intent Surgery after Neoadjuvant Therapy

 Hyun Kyung Yang  ;  Mi-Suk Park  ;  Kyunghwa Han  ;  Geonsik Eom  ;  Yong Eun Chung  ;  Jin-Young Choi  ;  Seungmin Bang  ;  Chang Moo Kang  ;  Jinsil Seong  ;  Myeong-Jin Kim 
 CANCER RESEARCH AND TREATMENT, Vol.56(1) : 247-258, 2024-01 
Journal Title
Issue Date
CA-19-9 Antigen ; Carcinoma, Pancreatic Ductal* / surgery ; Humans ; Neoadjuvant Therapy ; Pancreatic Neoplasms* / drug therapy ; Pancreatic Neoplasms* / surgery ; Prognosis ; Retrospective Studies ; Risk Assessment
CA-19-9 antigen ; Neoadjuvant therapy ; Pancreatic ductal carcinoma ; Prognosis ; X-ray computed tomography
Purpose Clinical prognostic criteria using preoperative factors were not developed for post–neoadjuvant therapy (NAT) surgery of pancreatic ductal adenocarcinoma (PDAC). We aimed to identify preoperative factors associated with overall survival (OS) in PDAC patients who underwent post-NAT curative-intent surgery and develop risk stratification criteria.Materials and Methods Consecutive PDAC patients who underwent post-NAT curative-intent surgeries between 2007 and 2020 were retrospectively analyzed. Demographic, laboratory, surgical, and histopathologic variables were collected. Baseline, preoperative, and interval changes of computed tomography (CT) findings proposed by the Society of Abdominal Radiology and the American Pancreatic Association were analyzed. Cox proportional hazard analysis was used to select preoperative variables associated with OS. We developed risk stratification criteria composed of the significant preoperative variables, i.e., post-NAT response criteria. We compared the discrimination performance of post-NAT response criteria with that of post-NAT pathological (yp) American Joint Cancer Committee TNM staging system.Results One hundred forty-five PDAC patients were included. Stable or increased tumor size on CT (hazard ratio [HR], 2.58; 95% confidence interval [CI], 1.58 to 4.21; p < 0.001) and elevated preoperative carbohydrate antigen 19-9 (CA19-9) level (HR, 1.98; 95% CI, 1.11 to 3.55; p=0.021) were independent factors of OS. The OS of the patient groups stratified by post-NAT response criteria which combined changes in tumor size and CA19-9 showed significant difference (p < 0.001). Such stratification was comparable to ypTNM staging in discrimination performance (difference of C-index, 0.068; 95% CI, –0.012 to 0.142).Conclusion “Any degree of decrease in tumor size on CT” and CA19-9 normalization or staying normal were independent favorable factors of OS. The combination of the two factors discriminated OS comparably to ypTNM staging.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Park, Mi-Suk(박미숙) ORCID logo https://orcid.org/0000-0001-5817-2444
Bang, Seungmin(방승민) ORCID logo https://orcid.org/0000-0001-5209-8351
Seong, Jin Sil(성진실) ORCID logo https://orcid.org/0000-0003-1794-5951
Yang, Hyun Kyung(양현경) ORCID logo https://orcid.org/0000-0003-3576-9146
Chung, Yong Eun(정용은) ORCID logo https://orcid.org/0000-0003-0811-9578
Choi, Jin Young(최진영) ORCID logo https://orcid.org/0000-0002-9025-6274
Han, Kyung Hwa(한경화)
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