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Tumor marker recovery rather than major pathological response is a preferable prognostic factor in patients with pancreatic ductal adenocarcinoma with preoperative therapy
Author(s) -
Yamada Suguru,
Yokoyama Yukihiro,
Sonohara Fuminori,
Yamaguchi Junpei,
Takami Hideki,
Hayashi Masamichi,
Onoe Shunsuke,
Fujii Tsutomu,
Nagino Masato,
Kodera Yasuhiro
Publication year - 2020
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.748
Subject(s) - pathological , medicine , grading (engineering) , pancreatic ductal adenocarcinoma , pathological staging , adenocarcinoma , oncology , proportional hazards model , tumor marker , gastroenterology , pancreatic cancer , cancer , civil engineering , engineering
Background/Purpose A pathological response of the primary tumor by preoperative therapy is a prognostic factor in various malignancies, and several histologic grading systems have been proposed for pancreatic ductal adenocarcinoma (PDAC). However, the prognostic value remains unclear. We explored the clinical implication of a major pathological response following preoperative therapy in patients with PDAC. Methods Of 415 patients with resected PDAC, 137 who had undergone preoperative therapy were examined. Cox proportional hazards models were used to determine the predictors of a major pathological response, and survival analyses were performed. Results Twenty patients exhibited a major pathological response (≥90% tumor reduction). Significant associations were observed between a major pathological response and resectability ( P = .001), the period of preoperative therapy ( P < .001), RECIST best response ( P < .001), the tumor size after preoperative therapy ( P = .02), and tumor marker recovery ( P < .001). Multivariate analysis of progression‐free survival (PFS) revealed that both body mass index (≥20 kg/m 2 ) ( P = .035) and tumor marker recovery ( P = .046) were independent prognostic factors. The median survival time (MST) of PFS for a ≥90% pathological response was better than that of a <90% response ( P = .25); however, the MST for tumor marker recovery was significantly better than that without tumor marker recovery ( P = .0054). Conclusions In our study, a major pathological response was not extracted as a prognostic factor. Rather, tumor marker recovery was a preferable prognostic factor in patients with PDAC who had undergone preoperative therapy.