Normalization of the Tumor Marker and a Clear Resection Margin Affect Progression-Free Survival of Patients with Unresectable Pancreatic Cancer who have Undergone Conversion Surgery

Research Square (Research Square)(2022)

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Abstract
Abstract Background With the advent of intensive combination systemic regimens, an increasing number of patients with UPC regain the opportunity of operation. To investigated the clinical benefits and prognostic factors of conversion surgery (CS) in patients with unresectable pancreatic cancer (UPC). Methods We retrospectively enrolled patients with UPC who had received CS following first-line systemic treatment in our center between 2014 to 2022. Treatment response, safety of the surgical procedure and clinicopathological data were collected. We analyzed the prognostic factors for postoperative survival among UPC patients who had CS. Results Sixty-seven patients with UPC were enrolled (53 with locally advanced pancreatic cancer (LAPC) and 14 with metastatic pancreatic cancer (MPC)). The duration of preoperative systemic treatment was 4.17 months for LAPC patients and 6.52 months for MPC patients. All patients experienced a partial response (PR) or stable disease (SD) preoperatively according to imaging. Tumor resection was unsuccessful in four patients and, finally, R0 resection was obtained in 81% of cases. Downstaging was determined pathologically in 87% of cases; four patients achieved a complete pathological response. Median postoperative-progression-free survival (PO-PFS) was 9.77 months and postoperative overall survival (PO-OS) was 31.2 months. Multivariate logistic regression analyses revealed that the resection margin and postoperative changes in levels of tumor markers were significant prognostic factors for PO-PFS. No factors were associated significantly with PO-OS according to multivariate analyses. Conclusions CS is a promising strategy for improving the prognosis of UPC patients. The resection margin and postoperative change in levels of tumor markers are the most important prognostic factors for prolonged PFS.
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Key words
pancreatic cancer,undergone conversion surgery,tumor marker,progression-free
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