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01-03-2008 | original article

Postoperative Adjuvant Chemotherapy Improves Survival after Surgical Resection for Pancreatic Carcinoma

Authors: Yoshiaki Murakami, Kenichiro Uemura, Takeshi Sudo, Yasuo Hayashidani, Yasushi Hashimoto, Hiroki Ohge, Taijiro Sueda

Published in: Journal of Gastrointestinal Surgery | Issue 3/2008

Abstract

Pancreatic carcinoma is one of the most aggressive types of gastrointestinal malignancy, and its prognosis remains extremely dismal. The aim of this study was to identify useful prognostic factors for patients undergoing surgical resection for pancreatic carcinoma. Medical records of 89 patients with pancreatic carcinoma who underwent surgical resection were retrospectively reviewed. Univariate and multivariate models were used to analyze the effect of various clinicopathological factors on long-term survival. There were no operative deaths. Overall 1-, 2-, and 5-year survival rates were 59, 28, and 7%, respectively (median survival time, 12.1 months). Univariate analysis revealed that postoperative adjuvant chemotherapy, portal vein invasion, lymph node metastasis, extrapancreatic nerve plexus invasion, surgical margin status, UICC pT factor, and UICC stage were significantly associated with long-term survival (P < 0.01). Furthermore, use of postoperative adjuvant chemotherapy and absence of extrapancreatic nerve plexus invasion were found to be significant independent predictors of a favorable prognosis using a Cox proportional hazard regression model (P < 0.05). These results suggest that postoperative adjuvant chemotherapy may improve survival after surgical resection for pancreatic carcinoma and that extrapancreatic nerve plexus invasion indicates a poor prognosis for long-term survival.

American Cancer Society. Cancer facts and figures 2004. Atlanta, GA: American Cancer Society; 2004.

Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. CA Cancer J Clin 2000;50:7–33.PubMedCrossRef

Murakami Y, Uemura K, Sasaki T, Hayashidani Y, Sudo T, Sueda T. Long-term survival of pancreatic cancer patient diagnosed by positive telomerase activity of pancreatic juice. Surgery 2005;138:962–963.PubMedCrossRef

Tan HP, Smith J, Garberoglio CA. Pancreatic adenocarcinoma: an update. J Am Coll Surg 1996;183:164–184.PubMed

Sener SF, Fremgen A, Menck HR, Winchester DP. Pancreatic cancer: A report of treatment and survival trends for 100,313 patients diagnosed from 1985–1995, using the National Cancer Database. J Am Coll Surg 1999;189:1–7.PubMedCrossRef

Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg 2006;10:1199–1211.PubMedCrossRef

Shimada K, Sakamoto Y, Sano T, Kosuge T. Prognostic factors after distal pancreatectomy with extended lymphadenectomy for invasive pancreatic adenocarcinoma of the body and tail. Surgery 2006;139:288–295.PubMedCrossRef

Moon HJ, An JY, Heo JS, Choi SH, Joh JW, Kim YI. Predicting survival after surgical resection for pancreatic ductal adenocarcinoma. Pancreas 2006;32:37–43.PubMedCrossRef

Tani M, Kawai M, Terasawa H, Ina S, Hirono S, Uchiyama K, Yamaue H. Does postoperative chemotherapy have a survival benefit for patients with pancreatic cancer? J Surg Oncol 2006;93:485–490.PubMedCrossRef

10.

Jamieson NB, Glen P, McMillan DC, McKay CJ, Foulis AK, Carter R, Imrie CW. Systemic inflammatory response predicts outcome in patients undergoing resection for ductal adenocarcinoma head of pancreas. Br J Cancer 2005;92:21–23.PubMedCrossRef

11.

Shibata K, Matsumoto T, Yada K, Sasaki A, Ohta M, Kitano S. Factors predicting recurrence after resection of pancreatic ductal carcinoma. Pancreas 2005;31:69–73.PubMedCrossRef

12.

Brown KM, Domin C, Aranha GV, Yong S, Shoup M. Increased preoperative platelet count is associated with decreased survival after resection for adenocarcinoma of the pancreas. Am J Surg 2005;189:278–282.PubMedCrossRef

13.

Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Buchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 2004;91:586–594.PubMedCrossRef

14.

Kuhlmann KF, de Castro SM, Wesseling JG, ten Kate FJ, Offerhaus GJ, Busch OR, van Gulik TM, Obertop H, Gouma DJ. Surgical treatment of pancreatic adenocarcinoma; actual survival and prognostic factors in 343 patients. Eur J Cancer 2004;40:549–558.PubMedCrossRef

15.

Berger AC, Meszoely IM, Ross EA, Watson JC, Hoffman JP. Undetectable preoperative levels of serum CA 19-9 correlate with improved survival for patients with resectable pancreatic adenocarcinoma. Ann Surg Oncol 2004;11:644–649.PubMedCrossRef

16.

Richter A, Niedergethmann M, Sturm JW, Lorenz D, Post S, Trede M. Long-term results of partial pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head: 25-year experience. World J Surg 2003;27:324–329.PubMedCrossRef

17.

Takai S, Satoi S, Toyokawa H, Yanagimoto H, Sugimoto N, Tsuji K, Araki H, Matsui Y, Imamura A, Kwon AH, Kamiyama Y. Clinicopathologic evaluation after resection for ductal adenocarcinoma of the pancreas: A retrospective, single-institution experience. Pancreas 2003;26:243–249.PubMedCrossRef

18.

Gebhardt C, Meyer W, Reichel M, Wunsch PH. Prognostic factors in the operative treatment of ductal pancreatic carcinoma. Langenbecks Arch Surg 2000;385:14–20.PubMedCrossRef

19.

Wenger FA, Peter F, Zieren J, Steiert A, Jacobi CA, Muller JM. Prognosis factors in carcinoma of the head of the pancreas. Dig Surg 2000;17:29–35.PubMedCrossRef

20.

Magistrelli P, Antinori A, Crucitti A, La Greca A, Masetti R, Coppola R, Nuzzo G, Picciocchi A. Prognostic factors after surgical resection for pancreatic carcinoma. J Surg Oncol 2000;74:36–40.PubMedCrossRef

21.

Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA, Sauter PK, Coleman J, Hruban RH, Lillemoe KD. Resected adenocarcinoma of the pancreas—616 patients: Results, outcomes, and prognostic indicators. J Gastrointest Surg 2000;4:567–579.PubMedCrossRef

22.

Fortner JG. Regional resection of cancer of the pancreas: a new surgical approach. Surgery 1973;73:307–320.PubMed

23.

Kayahara M, Nagakawa T, Ueno K, Ohta T, Tsukioka Y, Miyazaki I. Surgical strategy for carcinoma of the pancreas head area based on clinicopathologic analysis of nodal involvement and plexus invasion. Surgery 1995;117:616–623.PubMedCrossRef

24.

Farnell MB, Pearson RK, Sarr MG, DiMagno EP, Burgart LJ, Dahl TR, Foster N, Sargent DJ, Pancreas Cancer Working Group. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery 2005;138:618–630.PubMedCrossRef

25.

Yeo CJ, Cameron JL, Sohn TA, Coleman J, Sauter PK, Hruban RH, Pitt HA, Lillemoe KD. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: Comparison of morbidity and mortality and short-term outcome. Ann Surg 1999;229:613–624.PubMedCrossRef

26.

Pedrazzoli S, DiCarlo V, Dionigi R, Mosca F, Pederzoli P, Pasquali C, Kloppel G, Dhaene K, Michelassi F. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: A multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg 1998;228:508–517.PubMedCrossRef

27.

Traverso LW. Pancreatic cancer: surgery alone is not sufficient. Surg Endosc 2006;20:S446–449.PubMedCrossRef

28.

Trede M, Richter A, Wendl K. Personal observations, opinions, and approaches to cancer of the pancreas and the periampullary area. Surg Clin North Am 2001;81:595–610.PubMedCrossRef

29.

Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, Beger H, Fernandez-Cruz L, Dervenis C, Lacaine F, Falconi M, Pederzoli P, Pap A, Spooner D, Kerr DJ, Buchler MW, European Study Group for Pancreatic Cancer. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004;350:1200–1210.PubMedCrossRef

30.

Murakami Y, Uemura K, Ohge H, Hayashidani Y, Sudo T, Sueda T. Intraductal papillary-mucinous neoplasms and mucinous cystic neoplasms of the pancreas differentiated by ovarian-type stroma. Surgery 2006;140:448–453.PubMedCrossRef

31.

Murakami Y, Uemura K, Hayashidani Y, Sudo T, Sueda T. Predictive factors of malignant or invasive intraductal papillary–mucinous neoplasms of the pancreas. J Gastrointest Surg 2007;11:338–344.PubMedCrossRef

32.

International Union Agains Cancer (UICC). TNM classification of malignant tumors, 6th edn. New York: Wiley-Liss; 2002.

33.

Gastrointestinal Tumor Study Group. Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Cancer 1987;59:2006–2010.CrossRef

34.

Bakkevold KE, Arnesjo B, Dahl O, Kambestad B. Adjuvant combination chemotherapy (AMF) following radical resection of carcinoma of the pancreas and papilla of Vater–results of a controlled, prospective, randomised multicentre study. Eur J Cancer 1993;29A(5):698–703.PubMedCrossRef

35.

Klinkenbijl JH, Jeekel J, Sahmoud T, van Pel R, Couvreur ML, Veenhof CH, Arnaud JP, Gonzalez DG, de Wit LT, Hennipman A, Wils J. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 1999;230:776–784.PubMedCrossRef

36.

Takada T, Amano H, Yasuda H, Nimura Y, Matsushiro T, Kato H, Nagakawa T, Nakayama T, Study Group of Surgical Adjuvant Therapy for Carcinomas of the Pancreas and Biliary Tract. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer 2002;95:1685–1695.PubMedCrossRef

37.

Kosuge T, Kiuchi T, Mukai K, Kakizoe T, Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer (JSAP). A multicenter randomized controlled trial to evaluate the effect of adjuvant cisplatin and 5-fluorouracil therapy after curative resection in cases of pancreatic cancer. Jpn J Clin Oncol 2006;36:159–165.PubMedCrossRef

38.

Stocken DD, Buchler MW, Dervenis C, Bassi C, Jeekel H, Klinkenbijl JH, Bakkevold KE, Takada T, Amano H, Neoptolemos JP, Pancreatic Cancer Meta-analysis Group. Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer. Br J Cancer 2005;92:1372–1381.PubMedCrossRef

39.

Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, Schramm H, Fahlke J, Zuelke C, Burkart C, Gutberlet K, Kettner E, Schmalenberg H, Weigang-Koehler K, Bechstein WO, Niedergethmann M, Schmidt-Wolf I, Roll L, Doerken B, Riess H. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007;297:267–277.PubMedCrossRef

40.

Burris HA 3rd, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, Cripps MC, Portenoy RK, Storniolo AM, Tarassoff P, Nelson R, Dorr FA, Stephens CD, Von Hoff DD. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: A randomized trial. J Clin Oncol 1997;15:2403–2413.PubMed

41.

Ueno H, Okusaka T, Ikeda M, Takezako Y, Morizane C. An early phase II study of S-1 in patients with metastatic pancreatic cancer. Oncology 2005;68:171–178.PubMedCrossRef

42.

Ueno H, Okusaka T, Funakoshi A, Ishii H, Yamao K, Ishikawa O, Ohkawa S, Saitoh S. A phase II study of weekly irinotecan as first-line therapy for patients with metastatic pancreatic cancer. Cancer Chemother Pharmacol 2007;59:447–454.PubMedCrossRef

43.

Nakamura K, Yamaguchi T, Ishihara T, Sudo K, Kato H, Saisho H. Phase II trial of oral S-1 combined with gemcitabine in metastatic pancreatic cancer. Br J Cancer 2006;94:1575–1579.PubMed

44.

Nakao A, Harada A, Nonami T, Kaneko T, Takagi H. Clinical significance of carcinoma invasion of the extrapancreatic nerve plexus in pancreatic cancer. Pancreas 1996;12:357–361.PubMedCrossRef

45.

Nagakawa T, Kayahara M, Ueno K, Ohta T, Konishi I, Ueda N, Miyazaki I. A clinicopathologic study on neural invasion in cancer of the pancreatic head. Cancer 1992;69:930–935.PubMedCrossRef

46.

Takahashi T, Ishikura H, Motohara T, Okushiba S, Dohke M, Katoh H. Perineural invasion by ductal adenocarcinoma of the pancreas. J Surg Oncol 1997;65:164–170.PubMedCrossRef

47.

Tamm EP, Loyer EM, Faria S, Raut CP, Evans DB, Wolff RA, Crane CH, Dubrow RA, Charnsangavej C. Staging of pancreatic cancer with multidetector CT in the setting of preoperative chemoradiation therapy. Abdom Imaging 2006;31:568–74.PubMedCrossRef

48.

Talamonti MS, Small W Jr, Mulcahy MF, Wayne JD, Attaluri V, Colletti LM, Zalupski MM, Hoffman JP, Freedman GM, Kinsella TJ, Philip PA, McGinn CJ. A multi-institutional phase II trial of preoperative full-dose gemcitabine and concurrent radiation for patients with potentially resectable pancreatic carcinoma. Ann Surg Oncol 2006;13:150–158.PubMedCrossRef

Title: Postoperative Adjuvant Chemotherapy Improves Survival after Surgical Resection for Pancreatic Carcinoma
Authors: Yoshiaki Murakami
Kenichiro Uemura
Takeshi Sudo
Yasuo Hayashidani
Yasushi Hashimoto
Hiroki Ohge
Taijiro Sueda
Publication date: 01-03-2008
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 3/2008
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-007-0407-5

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Postoperative Adjuvant Chemotherapy Improves Survival after Surgical Resection for Pancreatic Carcinoma

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