The Value of Biological and Conditional Factors for Staging of Patients with Resectable Pancreatic Cancer Undergoing Upfront Resection: A Nationwide Analysis

Dutch Pancreatic Cancer Group, Thijs J Schouten, Iris W J M van Goor, Galina A Dorland, Marc G Besselink, Bert A Bonsing, Koop Bosscha, Lodewijk A A Brosens, Olivier R Busch, Geert A Cirkel, Ronald M van Dam, Sebastiaan Festen, Bas Groot Koerkamp, Erwin van der Harst, Ignace H J T de Hingh, Martijn P W Intven, Geert Kazemier, Mike S L Liem, Krijn P van Lienden, Maartje LosVincent E de Meijer, Gijs A Patijn, Jennifer M J Schreinemakers, Martijn W J Stommel, Geert Jan van Tienhoven, Robert C Verdonk, Helena M Verkooijen, Hjalmar C van Santvoort, I Quintus Molenaar, Lois A Daamen*

*Bijbehorende auteur voor dit werk

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BACKGROUND: Novel definitions suggest that resectability status for pancreatic ductal adenocarcinoma (PDAC) should be assessed beyond anatomical criteria, considering both biological and conditional factors. This has, however, yet to be validated on a nationwide scale. This study evaluated the prognostic value of biological and conditional factors for staging of patients with resectable PDAC.

PATIENTS AND METHODS: A nationwide observational cohort study was performed, including all consecutive patients who underwent upfront resection of National Comprehensive Cancer Network resectable PDAC in the Netherlands (2014-2019) with complete information on preoperative carbohydrate antigen (CA) 19-9 and Eastern Cooperative Oncology Group (ECOG) performance status. PDAC was considered biologically unfavorable (R B+) if CA19-9 ≥ 500 U/mL and favorable (R B-) otherwise. ECOG ≥ 2 was considered conditionally unfavorable (R C+) and favorable otherwise (R C-). Overall survival (OS) was assessed using Kaplan-Meier and Cox-proportional hazard analysis, presented as hazard ratios (HRs) with 95% confidence interval (CI).

RESULTS: Overall, 688 patients were analyzed with a median overall survival (OS) of 20 months (95% CI 19-23). OS was 14 months (95% CI 10 months-median not reached) in 20 R B+C+ patients (3%; HR 1.61, 95% CI 0.86-2.70), 13 months (95% CI 11-15) in 156 R B+C- patients (23%; HR 1.86, 95% CI 1.50-2.31), and 21 months (95% CI 12-41) in 47 R B-C+ patients (7%; HR 1.14, 95% CI 0.80-1.62) compared with 24 months (95% CI 22-27) in 465 patients with R B-C- PDAC (68%; reference).

CONCLUSIONS: Survival after upfront resection of anatomically resectable PDAC is worse in patients with CA19-9 ≥ 500 U/mL, while performance status had no impact. This supports consideration of CA19-9 in preoperative staging of resectable PDAC.

Originele taal-2English
TijdschriftAnnals of surgical oncology
StatusE-pub ahead of print - 22-feb.-2024

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