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Neoadjuvant gemcitabine and nab‐paclitaxel for borderline resectable pancreatic cancers: Intention‐to‐treat analysis compared with upfront surgery
Author(s) -
Inoue Yosuke,
Saiura Akio,
Oba Atsushi,
Ono Yoshihiro,
Mise Yoshihiro,
Ito Hiromichi,
Sasaki Takashi,
Ozaka Masato,
Sasahira Naoki,
Takahashi Yu
Publication year - 2021
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.844
Subject(s) - medicine , gemcitabine , surgery , neoadjuvant therapy , retrospective cohort study , nat , cohort , pancreatic cancer , chemotherapy , gastroenterology , cancer , oncology , breast cancer , computer network , computer science
Abstract Background/Purpose We evaluated efficacy of neoadjuvant therapy with gemcitabine and nab‐paclitaxel (GNP‐NAT) in borderline resectable pancreatic cancer (BR‐PC) patients compared to conventional upfront surgery (UPS). Methods This single‐center retrospective study assessed 151 consecutive patients: 96 diagnosed in 2008‐2014 underwent UPS (UPS group) and 55 diagnosed in 2015‐2017 underwent GNP‐NAT (GN group). Patient background, surgical, pathological, and survival outcomes were compared between groups. Results Age, sex, and pretreatment carbohydrate antigen 19‐9 were similar between groups. After four courses of NAT‐GNP, 46 GN patients (84%) underwent surgery while all UPS patients underwent surgery. Only three GN patients (5%) underwent non‐therapeutic procedures, compared to 23 (24%) in the UPS group ( P = .004). In the whole cohort, R0‐resection was achieved in 40 GN patients (73%) vs 46 UPS patients (48%; P = .004) and the 3‐year overall survival was significantly higher in the GN group (median survival time, 31.9 vs 18.1 months, P = .014). In the resection cohort, the R0‐resection rate was 93% (GN) vs 63% (UPS; P = .0007). There was no 90‐day mortalities in either group. Conclusions Intention‐to‐treat‐based analysis indicated considerable benefits of GNP‐NAT in BR‐PCs for long‐term survival, contributing to improved tumor suppression and patient selection.