Detailed Abstract
[Oral Presentation 1 - Biliary & Pancreas (Biliary Disease/Surgery)]
[OP 1-2] Pancreatectomy following neoadjuvant treatment can improve oncologic outcome in high metabolic active resectable pancreatic cancer
Ji Su KIM1 , Dong Woo KIM2 , Sung Hwan LEE3 , Chang Moo KANG*1
1 Department Of Hepatobiliary And Pancreatic Surgery, Yonsei University College Of Medicine, REPUBLIC OF KOREA
2 Department Of Nuclear Medicine, Yonsei University College Of Medicine, REPUBLIC OF KOREA
3 Department Of Hepatobiliary And Pancreatic Surgery, CHA Bundang Medical Center, CHA University, REPUBLIC OF KOREA
Background : Neoadjuvant chemotherapy is recommended for borderline resectable pancreatic ductal adenocarcinoma (R-PC). However, there is controversy about whether neoadjuvant chemotherapy can be used in patients with R-PC. In our previous study, high metabolic active R-PC is known to be associated with early systemic metastasis in resected PDAC. This study aims to compare the prognosis of high metabolic active R-PC according to the presence or absence of neoadjuvant chemotherapy.
Methods : From 2005 to 2019, a total of 244 patients with R-PC who underwent radical pancreatectomy at Severance Hospital. Among them, a total of 200 patients in T1,2,3 (7th edition) were analyzed retrospectively, excluding 11 patients with the lack of Positron Emission Tomography- computed tomography (PET-CT) data. The metabolic tumor volume (MTV) was measured in PET-CT by specialist of nuclear medicine.
Results : The patients were divided into an upfront surgery group (N=153) and a neoadjuvant treatment group (N=47), and in each group, high metabolically active PDAC was 79 and 29, respectively. In upfront surgery group, R-PC with high MTV2.5 (N=79) has worse median disease free survival (mDFS) than low MTV2.5 (N=74) (p=0.001). In R-PC with High MTV2.5, neoadjuvant chemotherapy group (N=29) has better mDFS than upfront surgery group (N=79) [10.30 (95%CI 7.821-12.779) vs 18.30 (95% CI 8.638-27.962), p = 0.04]. In R-PC with low MTV2.5, there was no significant difference in mDFS between two groups (20.97 (95%CI 16.20-25.74) vs 10.70 (2.94-18.46), p = 0.161).
Conclusions : Pancreatectomy following neoadjuvant treatment can improve oncologic outcome in high metabolic active R-PC. Neoadjuvant treatment need to be selectively applied for R-PC.
Methods : From 2005 to 2019, a total of 244 patients with R-PC who underwent radical pancreatectomy at Severance Hospital. Among them, a total of 200 patients in T1,2,3 (7th edition) were analyzed retrospectively, excluding 11 patients with the lack of Positron Emission Tomography- computed tomography (PET-CT) data. The metabolic tumor volume (MTV) was measured in PET-CT by specialist of nuclear medicine.
Results : The patients were divided into an upfront surgery group (N=153) and a neoadjuvant treatment group (N=47), and in each group, high metabolically active PDAC was 79 and 29, respectively. In upfront surgery group, R-PC with high MTV2.5 (N=79) has worse median disease free survival (mDFS) than low MTV2.5 (N=74) (p=0.001). In R-PC with High MTV2.5, neoadjuvant chemotherapy group (N=29) has better mDFS than upfront surgery group (N=79) [10.30 (95%CI 7.821-12.779) vs 18.30 (95% CI 8.638-27.962), p = 0.04]. In R-PC with low MTV2.5, there was no significant difference in mDFS between two groups (20.97 (95%CI 16.20-25.74) vs 10.70 (2.94-18.46), p = 0.161).
Conclusions : Pancreatectomy following neoadjuvant treatment can improve oncologic outcome in high metabolic active R-PC. Neoadjuvant treatment need to be selectively applied for R-PC.
SESSION
Oral Presentation 1
Room A 3/3/2022 2:20 PM - 3:20 PM