Clinical usefulness of conversion surgery for unresectable pancreatic cancer diagnosed on multidetector computed tomography imaging: Results from a multicenter observational cohort study by the Hokkaido Pancreatic Cancer Study Group (HOPS UR‐01)

• Published in: Annals of gastroenterological surgery Vol. 3; no. 5; pp. 523 - 533
• Main Authors: Kimura, Yasutoshi, Nakamura, Toru, Hayashi, Tsuyoshi, Kuwatani, Masaki, Motoya, Masayo, Yoshida, Makoto, Imamura, Masafumi, Nagayama, Minoru, Yamaguchi, Hiroshi, Yamakita, Keisuke, Goto, Takuma, Sakuhara, Yusuke, Takahashi, Kuniyuki, Maguchi, Hiroyuki, Hirano, Satoshi, Takemasa, Ichiro
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01.09.2019; John Wiley and Sons Inc; Wiley
• Subjects: Biomarkers; Cancer therapies; Cellular biology; Clinical trials; Cohort analysis; Endoscopy; Hospitals; Laparoscopy; locally advanced; Medical prognosis; Medical referrals; Metastasis; metastatic; multidisciplinary treatment; NMR; Nuclear magnetic resonance; Observational studies; Original; Pancreatic cancer; Patients; radical surgery; Studies; Surgery; unresectable pancreatic cancer; Japan; radical surgery; locally advanced; metastatic; unresectable pancreatic cancer; multidisciplinary treatment
• ISSN: 2475-0328; 2475-0328
• DOI: 10.1002/ags3.12272

Background and Aim Effective multidisciplinary approaches for unresectable pancreatic cancer (UR‐PC) that include modern chemotherapeutic regimens and subsequent conversion surgery (CS) are being developed. The aim of this study was to evaluate outcomes of patients clinically diagnosed with UR‐PC, focusing on the efficacy of CS. Methods Patients ineligible for two multicenter phase II studies conducted by the Hokkaido Pancreatic Cancer Study Group (HOPS) were recruited. Sequential treatment regimens, conversion to radical surgery, and overall survival (OS) were analyzed by multidetector computed tomography (MDCT)‐based UR factors. Univariate and multivariate analyses were performed to identify predictors of OS. Results Sixty‐six of 247 intended recruits for HOPS studies from October 2013 to April 2016 were included. Unresectability was due to locally advanced (LA) disease and metastasis (M) in 42 and 24 patients, respectively. Induction therapy began with chemotherapy (CT) and chemoradiotherapy (CRT) in 44 and 17 patients, respectively, of whom 23 received modern CT regimens. Radical surgery was completed in 12 (LA, 10; M, two) with a median treatment interval of 10.3 months (range, 2‐32). Eleven patients (91.6%) achieved pathological R0 resection. Median OS was significantly longer in patients who underwent CS than those who did not (44.1 vs 14.5 months, P < 0.0001). CS was an independent predictor of OS (hazard ratio, 0.078; 95% confident interval, 0.017‐0.348; P = 0.001). Conclusion Conversion surgery after a favorable response to sequential treatment might prolong survival in patients with UR‐PC. Precise diagnosis on MDCT followed by sequential multimodal anticancer treatment is essential. Kaplan‐Meier plots for survival by CS status and reason for initial unresectability. Overall survival of patients who completed CS was significantly longer than those who did not (44.1 vs 14.5 months, P < 0.0001).