Cancer Research and Treatment

Original Articles

Gastrointestinal cancer

Clinical Outcomes of Surgery after Neoadjuvant Chemotherapy in Locally Advanced Pancreatic Ductal Adenocarcinoma: Yoo Na Lee, Min Kyu Sung, Dae Wook Hwang, Yejong Park, Bong Jun Kwak, Woohyung Lee, Ki Byung Song, Jae Hoon Lee, Changhoon Yoo, Kyu-Pyo Kim, Heung-Moon Chang, Baek-Yeol Ryoo, Song Cheol Kim; Cancer Res Treat. 2024;56(4):1240-1251. Published online June 19, 2024; DOI: https://doi.org/10.4143/crt.2023.977

Abstract PDF PubReader ePub: Purpose
Clinical outcomes of surgery after neoadjuvant chemotherapy have not been investigated for locally advanced pancreatic cancer (LAPC), despite well-established outcomes in borderline resectable pancreatic cancer (BRPC). This study aimed to investigate the clinical outcomes of patients with LAPC who underwent curative resection following neoadjuvant chemotherapy.
Materials and Methods
We retrospectively reviewed the records of patients diagnosed with pancreatic adenocarcinoma between January 2017 and December 2020.
Results
Among 1,358 patients, 260 underwent surgery following neoadjuvant chemotherapy. Among 356 LAPC patients, 98 (27.5%) and 147 (35.1%) of 418 BRPC patients underwent surgery after neoadjuvant chemotherapy. Compared to resectable pancreatic cancer (resectable PC) with upfront surgery, both LAPC and BRPC exhibited higher rates of venous resection (28.6% vs. 49.0% vs. 4.0%), arterial resection (30.6% vs. 6.8% vs. 0.5%) and greater estimated blood loss (260.5 vs. 213.1 vs. 70.4 mL). However, hospital stay, readmission rates, and postoperative pancreatic fistula rates (grade B or C) did not differ significantly between LAPC, BRPC, and resectable PC. Overall and relapse-free survival did not differ significantly between LAPC and BRPC patients. The median overall survival was 37.3 months for LAPC and 37.0 months for BRPC. The median relapse-free survival was 22.7 months for LAPC and 26.0 months for BRPC.
Conclusion
Overall survival time and postoperative complications in LAPC patients who underwent curative resection following neoadjuvant chemotherapy showed similar results to those of BRPC patients. Further research is needed to identify specific sub-populations of LAPC patients who benefit most from conversion surgery and to minimize postoperative complications.

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Analysis of Plasma Circulating Tumor DNA in Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Modified FOLFIRINOX: Clinical Relevance of DNA Damage Repair Gene Alteration Detection: Dong-Hoon Lim, Hyunseok Yoon, Kyu-pyo Kim, Baek-Yeol Ryoo, Sang Soo Lee, Do Hyun Park, Tae Jun Song, Dae Wook Hwang, Jae Hoon Lee, Ki Byung Song, Song Cheol Kim, Seung-Mo Hong, Jaewon Hyung, Changhoon Yoo; Cancer Res Treat. 2023;55(4):1313-1320. Published online May 4, 2023; DOI: https://doi.org/10.4143/crt.2023.452

Abstract PDF Supplementary Material PubReader ePub

Purpose
There are no reliable biomarkers to guide treatment for patients with borderline resectable pancreatic cancer (BRPC) in the neoadjuvant setting. We used plasma circulating tumor DNA (ctDNA) sequencing to search biomarkers for patients with BRPC receiving neoadjuvant mFOLFIRINOX in our phase 2 clinical trial (NCT02749136).
Materials and Methods
Among the 44 patients enrolled in the trial, patients with plasma ctDNA sequencing at baseline or post-operation were included in this analysis. Plasma cell-free DNA isolation and sequencing were performed using the Guardant 360 assay. Detection of genomic alterations, including DNA damage repair (DDR) genes, were examined for correlations with survival.
Results
Among the 44 patients, 28 patients had ctDNA sequencing data qualified for the analysis and were included in this study. Among the 25 patients with baseline plasma ctDNA data, 10 patients (40%) had alterations of DDR genes detected at baseline, inclu-ding ATM, BRCA1, BRCA2 and MLH1, and showed significantly better progression-free survival than those without such DDR gene alterations detected (median, 26.6 vs. 13.5 months; log-rank p=0.004). Patients with somatic KRAS mutations detected at baseline (n=6) had significantly worse overall survival (median, 8.5 months vs. not applicable; log-rank p=0.003) than those without. Among 13 patients with post-operative plasma ctDNA data, eight patients (61.5%) had detectable somatic alterations.
Conclusion
Detection of DDR gene mutations from plasma ctDNA at baseline was associated with better survival outcomes of pati-ents with borderline resectable pancreatic ductal adenocarcinoma treated with neoadjuvant mFOLFIRINOX and may be a prognostic biomarker.

Citations

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A Review of Circulating Tumor DNA (ctDNA) in Pancreatic Cancer: Ready for the Clinic?
Purvi Jonnalagadda, Virginia Arnold, Benjamin A. Weinberg
Journal of Gastrointestinal Cancer.2025;[Epub] CrossRef
A Practical Approach to Interpreting Circulating Tumor DNA in the Management of Gastrointestinal Cancers
Zexi Allan, David S Liu, Margaret M Lee, Jeanne Tie, Nicholas J Clemons
Clinical Chemistry.2024; 70(1): 49. CrossRef
High somatic mutations in circulating tumor DNA predict response of metastatic pancreatic ductal adenocarcinoma to first-line nab-paclitaxel plus S-1: prospective study
Lei Huang, Yao Lv, Shasha Guan, Huan Yan, Lu Han, Zhikuan Wang, Quanli Han, Guanghai Dai, Yan Shi
Journal of Translational Medicine.2024;[Epub] CrossRef
Decoding the Dynamics of Circulating Tumor DNA in Liquid Biopsies
Khadija Turabi, Kelsey Klute, Prakash Radhakrishnan
Cancers.2024; 16(13): 2432. CrossRef
Building on the clinical applicability of ctDNA analysis in non-metastatic pancreatic ductal adenocarcinoma
Ibone Labiano, Ana E. Huerta, Maria Alsina, Hugo Arasanz, Natalia Castro, Saioa Mendaza, Arturo Lecumberri, Iranzu Gonzalez-Borja, David Guerrero-Setas, Ana Patiño-Garcia, Gorka Alkorta-Aranburu, Irene Hernández-Garcia, Virginia Arrazubi, Elena Mata, Davi
Scientific Reports.2024;[Epub] CrossRef
Liquid biopsy analysis of lipometabolic exosomes in pancreatic cancer
Wei Guo, Peiyao Ying, Ruiyang Ma, Zuoqian Jing, Gang Ma, Jin Long, Guichen Li, Zhe Liu
Cytokine & Growth Factor Reviews.2023; 73: 69. CrossRef

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Survival Benefit of Adjuvant Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma Who Underwent Surgery Following Neoadjuvant FOLFIRINOX: So Heun Lee, Dae Wook Hwang, Changhoon Yoo, Kyu-pyo Kim, Sora Kang, Jae Ho Jeong, Dongwook Oh, Tae Jun Song, Sang Soo Lee, Do Hyun Park, Dong Wan Seo, Jin-hong Park, Ki Byung Song, Jae Hoon Lee, Woohyung Lee, Yejong Park, Bong Jun Kwak, Heung-Moon Chang, Baek-Yeol Ryoo, Song Cheol Kim; Cancer Res Treat. 2023;55(3):956-968. Published online February 27, 2023; DOI: https://doi.org/10.4143/crt.2022.409

Abstract PDF Supplementary Material PubReader ePub

Purpose
The benefit of adjuvant chemotherapy following curative-intent surgery in pancreatic ductal adenocarcinoma (PDAC) patients who had received neoadjuvant FOLFIRINOX is unclear. This study aimed to assess the survival benefit of adjuvant chemotherapy in this patient population.
Materials and Methods
This retrospective study included 218 patients with localized non-metastatic PDAC who received neoadjuvant FOLFIRINOX and underwent curative-intent surgery (R0 or R1) between January 2017 and December 2020. The association of adjuvant chemotherapy with disease-free survival (DFS) and overall survival (OS) was evaluated in overall patients and in the propensity score matched (PSM) cohort. Subgroup analysis was conducted according to the pathology-proven lymph node status.
Results
Adjuvant chemotherapy was administered to 149 patients (68.3%). In the overall cohort, the adjuvant chemotherapy group had significantly improved DFS and OS compared to the observation group (DFS: median, 13.8 months [95% confidence interval (CI), 11.0 to 19.1] vs. 8.2 months [95% CI, 6.5 to 12.0]; p < 0.001; and OS: median, 38.0 months [95% CI, 32.2 to not assessable] vs. 25.7 months [95% CI, 18.3 to not assessable]; p=0.005). In the PSM cohort of 57 matched pairs of patients, DFS and OS were better in the adjuvant chemotherapy group than in the observation group (p < 0.001 and p=0.038, respectively). In the multivariate analysis, adjuvant chemotherapy was a significant favorable prognostic factor (vs. observation; DFS: hazard ratio [HR], 0.51 [95% CI, 0.36 to 0.71; p < 0.001]; OS: HR, 0.45 [95% CI, 0.29 to 0.71; p < 0.001]).
Conclusion
Among PDAC patients who underwent surgery following neoadjuvant FOLFIRINOX, adjuvant chemotherapy may be associated with improved survival. Randomized studies should be conducted to validate this finding.

Citations

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The survival effect of neoadjuvant therapy and neoadjuvant plus adjuvant therapy on pancreatic ductal adenocarcinoma patients with different TNM stages: a propensity score matching analysis based on the SEER database
Hao Hu, Yang Xu, Qiang Zhang, Yuan Gao, Zhenyu Wu
Expert Review of Anticancer Therapy.2024; 24(6): 467. CrossRef
Neoadjuvant treatment of pancreatic ductal adenocarcinoma: Whom, when and how
Nebojsa Manojlovic, Goran Savic, Stevan Manojlovic
World Journal of Gastrointestinal Surgery.2024; 16(5): 1223. CrossRef
Case Study on Analysing the Early Disease Detection of Pancreatic Ductal Adenocarcinoma in Korean Association for Clinical Oncology
Sijithra Ponnarassery Chandran, N. Santhi
American Journal of Clinical Oncology.2024; 47(10): 475. CrossRef
Evaluating the benefits of adjuvant chemotherapy in patients with pancreatic cancer undergoing radical pancreatectomy after neoadjuvant therapy—a systematic review and meta-analysis
Jiahao Wu, Yike Zhang, Haodong Wang, Wenyi Guo, Chengqing Li, Yichen Yu, Han Liu, Feng Li, Lei Wang, Jianwei Xu
Frontiers in Oncology.2024;[Epub] CrossRef
Prognostic factors in localized pancreatic ductal adenocarcinoma after neoadjuvant therapy and resection: a systematic review and meta-analysis
Ammar A Javed, Alyssar Habib, Omar Mahmud, Asad Saulat Fatimi, Mahip Grewal, Nabiha Mughal, Jin He, Christopher L Wolfgang, Lois Daamen, Marc G Besselink
JNCI: Journal of the National Cancer Institute.2024;[Epub] CrossRef

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Adjuvant Chemotherapy for Resected Ampulla of Vater Carcinoma: Retrospective Analysis of 646 Patients: Jwa Hoon Kim, Jae Ho Jeong, Baek-Yeol Ryoo, Kyu-pyo Kim, Heung-Moon Chang, Dongwook Oh, Tae Jun Song, Sang Soo Lee, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim, Yejong Park, Jae Woo Kwon, Dae Wook Hwang, Jae Hoon Lee, Woohyung Lee, Song Cheol Kim, Changhoon Yoo, Ki Byung Song; Cancer Res Treat. 2021;53(2):424-435. Published online November 9, 2020; DOI: https://doi.org/10.4143/crt.2020.953

Abstract PDF Supplementary Material PubReader ePub

Purpose
This study evaluated the efficacy of adjuvant chemotherapy (AC) in patients with resected ampulla of Vater (AoV) carcinoma.
Materials and Methods
Data from 646 patients who underwent surgical resection at Asan Medical Center between 2000 and 2017 were retrospectively reviewed.
Results
The median age of the patients was 62 years, and 54.2% were male. Patients were classified into AC group (n=165, 25.5%) and no AC group (n=481, 74.5%). With a median follow-up duration of 88 months, in patients with stage I, II, III, median recurrence-free survival (RFS) was not reached, 44 months, and 15 months, respectively, and the median overall survival (OS) were not reached, 88 months and 35 months, respectively. Despite no statistical significance, RFS and OS were better in stage II patients with AC than in those without AC (median RFS, 151 months vs. 38 months; p=0.156 and median OS, 153 months vs. 74 months; p=0.299). In multivariate analysis for RFS and OS, TNM stage, R1 resection status, presence of lymphovascular invasion, and perineural invasion remained significant factors, whereas AC (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.54 to 1.00; p=0.052) was marginally related with RFS. After propensity score matching in only stage II/III patients, RFS and OS with AC were numerically longer than those without AC (HR, 0.80; 95% CI, 0.60 to 1.06; p=0.116 and HR, 0.77; 95% CI, 0.56 to 1.06; p=0.111).
Conclusion
AC with fluoropyrimidine did not improve survival of patients with resected AoV carcinoma. However, multivariate analysis with prognostic factors showed a marginally significant survival benefit with AC.

Citations

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Survival benefit of concurrent chemoradiotherapy for advanced ampulla of Vater cancer
Chae Hwa Kwon, Hyung Il Seo, Dong Uk Kim, Sung Yong Han, Suk Kim, Nam Kyung Lee, Seung Baek Hong, Ji Hyun Ahn, Young Mok Park, Byeong Gwan Noh
World Journal of Clinical Cases.2024; 12(2): 267. CrossRef
Prognostic efficacy of lymph node parameters in resected ampullary adenocarcinoma based on long-term follow-up data after adjuvant treatment
Namyoung Park, In Rae Cho, Sang Hyub Lee, Joo Seong Kim, Jin Ho Choi, Min Woo Lee, Woo Hyun Paik, Kwang Ro Joo, Ji Kon Ryu, Yong-Tae Kim
World Journal of Surgical Oncology.2024;[Epub] CrossRef
Adjuvant Chemotherapy and Effect on Long-Term Survival in Ampullary Adenocarcinoma: A Multicenter Cohort Study
Dong Woo Shin, Jae Min Lee, Jong-chan Lee, Hee Seung Lee, Seung Bae Yoon, Dong Kee Jang, Joo Kyung Park, Min Kyu Jung, Yoon Suk Lee, Jin-Hyeok Hwang
Journal of the American College of Surgeons.2023; 237(3): 501. CrossRef
Role of adjuvant chemotherapy on recurrence and survival in patients with resected ampulla of Vater carcinoma
Se Jun Park, Kabsoo Shin, In-Ho Kim, Tae Ho Hong, Younghoon Kim, Myung-ah Lee
World Journal of Gastrointestinal Oncology.2023; 15(4): 677. CrossRef
Remission from the 5-Fu-Based Chemotherapy to Gemcitabine-Based Chemotherapy-Based on the Pathological Classification of Periampullary Carcinoma: A Case Report and Literature Review
Wei Hu, Zhiqing Duan, Yinuo Zhang, Jing Liu, Jing Bao, Ruqing Gao, Yajie Tang, Tiande Liu, Hu Xiong, Wen Li, Xiaowei Fu, Shousheng Liao, Lu Fang, Bo Liang
OncoTargets and Therapy.2022; Volume 15: 891. CrossRef

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Prognostic Predictability of American Joint Committee on Cancer 8th Staging System for Perihilar Cholangiocarcinoma: Limited Improvement Compared with the 7th Staging System: Jong Woo Lee, Jae Hoon Lee, Yejong Park, Woohyung Lee, Jaewoo Kwon, Ki Byung Song, Dae Wook Hwang, Song Cheol Kim; Cancer Res Treat. 2020;52(3):886-895. Published online March 12, 2020; DOI: https://doi.org/10.4143/crt.2020.023

Abstract PDF PubReader ePub

Purpose
This study was conducted to evaluate the prognostic values of the 7th and 8th American Joint Committee on Cancer (AJCC) staging systems for patients with resected perihilar cholangiocarcinoma (PHCC).
Materials and Methods
A total of 348 patients who underwent major hepatectomy for PHCC between 2008 and 2015 were identified from a single center. Overall survival (OS) was estimated using the Kaplan-Meier method and compared across stage groups with the log-rank test. The concordance index was used to evaluate the prognostic predictability of the 8th AJCC staging system compared with that of the 7th.
Results
In the 8th edition, the stratification of each group of T classification improved compared to that in the 7th, as the survival rate of T4 decreased (T2, 31.2%; T3, 13.9%; T4, 15.1%; T1- T2, p=0.260; T2-T3, p=0.001; T3-T4, p=0.996). Both editions showed significant survival differences between each N category, except between N1 and N2 (p=0.063) in 7th edition. Differences of point estimates between the 8th and 7th T and N classification and overall stages were +0.028, +0.006, and +0.039, respectively (T, p=0.005; N, p=0.115; overall stage, p=0.005). In multivariable analysis, posthepatectomy liver failure, T category, N category, distant metastasis, histologic differentiation, intraoperative transfusion, and resection margin status were associated with OS.
Conclusion
The prognostic predictability of 8th AJCC staging for PHCC improved slightly, with statistical significance, compared to the 7th edition, but its overall performance is still unsatisfactory.

Citations

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Postoperative factors predicting outcomes in patients with Perihilar cholangiocarcinoma undergoing curative resection—a 10-year single-center experience
Hasan Ahmad Al-Saffar, Nicolai Schultz, Peter Nørrgaard Larsen, Eva Fallentin, Gro Linno Willemoe, Diana Elena Renteria Ramirez, Lucas Alexander Knøfler, Hans-Christian Pommergaard
Scandinavian Journal of Gastroenterology.2025; 60(1): 73. CrossRef
The preoperative scoring system combining neutrophil/lymphocyte ratio and CA19-9 predicts the long-term prognosis of intrahepatic cholangiocarcinoma patients undergoing curative liver resection
Shilei Bai, Xiaodong Shi, Yizhe Dai, Huifeng Wang, Yong Xia, Jian Liu, Kui Wang
BMC Cancer.2024;[Epub] CrossRef
Preoperative factors predicting outcomes in patients with suspected perihilar cholangiocarcinoma referred for curative resection— a single-center 10-year experience
HA Al-Saffar, PN Larsen, N Schultz, TS Kristensen, DE Renteria, LA Knøfler, HC Pommergaard
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
Evaluation of Four Lymph Node Classifications for the Prediction of Survival in Hilar Cholangiocarcinoma
Zhi-Peng Liu, Qing-Yi Zhang, Wei-Yue Chen, Yu-Yan Huang, Yan-Qi Zhang, Yi Gong, Yan Jiang, Jie Bai, Zhi-Yu Chen, Hai-Su Dai
Journal of Gastrointestinal Surgery.2022; 26(5): 1030. CrossRef
Impact of Positive Lymph Nodes and Resection Margin Status on the Overall Survival of Patients with Resected Perihilar Cholangiocarcinoma: The ENSCCA Registry
Lynn E. Nooijen, Jesus M. Banales, Marieke T. de Boer, Chiara Braconi, Trine Folseraas, Alejandro Forner, Waclaw Holowko, Frederik J. H. Hoogwater, Heinz-Josef Klümpen, Bas Groot Koerkamp, Angela Lamarca, Adelaida La Casta, Flora López-López, Laura Izquie
Cancers.2022; 14(10): 2389. CrossRef
Modification of the eighth AJCC/UICC staging system for perihilar cholangiocarcinoma: An alternative pathological staging system from cholangiocarcinoma-prevalent Northeast Thailand
Chaiwat Aphivatanasiri, Prakasit Sa-Ngiamwibool, Sakkarn Sangkhamanon, Piyapharom Intarawichian, Waritta Kunprom, Malinee Thanee, Piya Prajumwongs, Narong Khuntikeo, Attapol Titapun, Apiwat Jareanrat, Vasin Thanasukarn, Tharatip Srisuk, Vor Luvira, Kulyad
Frontiers in Medicine.2022;[Epub] CrossRef
Vascular invasion and lymph node metastasis mediate the effect of CA242 on prognosis in hilar cholangiocarcinoma patients after radical resection
Gang Heng, Benqi Huang, Yanbing Shen, Dan wang, Zhen Lan, Yuxuan Yao, Jianxin Zhang, Jiankun Jia, Chengcheng Zhang
Frontiers in Oncology.2022;[Epub] CrossRef
Development and validation of preoperative magnetic resonance imaging-based survival predictive nomograms for patients with perihilar cholangiocarcinoma after radical resection: A pilot study
Jian Zhao, Wei Zhang, Cheng-Lin Fan, Jun Zhang, Fang Yuan, Si-Yun Liu, Fu-Yu Li, Bin Song
European Journal of Radiology.2021; 138: 109631. CrossRef
A Novel Nomogram Based on Log Odds of Metastatic Lymph Nodes to Predict Overall Survival in Patients With Perihilar Cholangiocarcinoma After Surgery
Wenbo Zou, Chunyu Zhu, Zizheng Wang, Xianglong Tan, Chenggang Li, Zhiming Zhao, Minggen Hu, Rong Liu
Frontiers in Oncology.2021;[Epub] CrossRef
Prognostic Relevance of the Eighth Edition of TNM Classification for Resected Perihilar Cholangiocarcinoma
Hans-Michael Hau, Felix Meyer, Nora Jahn, Sebastian Rademacher, Robert Sucher, Daniel Seehofer
Journal of Clinical Medicine.2020; 9(10): 3152. CrossRef

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Efficacy and Safety of Pembrolizumab in Patients with Refractory Advanced Biliary Tract Cancer: Tumor Proportion Score as a Potential Biomarker for Response: Junho Kang, Jae Ho Jeong, Hee-Sang Hwang, Sang Soo Lee, Do Hyun Park, Dong Wook Oh, Tae Jun Song, Ki-Hun Kim, Shin Hwang, Dae Wook Hwang, Song Cheol Kim, Jin-hong Park, Seung-Mo Hong, Kyu-pyo Kim, Baek-Yeol Ryoo, Changhoon Yoo; Cancer Res Treat. 2020;52(2):594-603. Published online December 18, 2019; DOI: https://doi.org/10.4143/crt.2019.493

Abstract PDF PubReader ePub

Purpose
The current standard chemotherapy for advanced biliary tract cancer (BTC) has limited benefit, and novel therapies need to be investigated.
Materials and Methods
In this prospective cohort study, programmed death ligand-1 (PD-L1)–positive BTC patients who progressed on first-line gemcitabine plus cisplatin were enrolled. Pembrolizumab 200 mg was administered intravenously every 3 weeks.
Results
Between May 2018 and February 2019, 40 patients were enrolled. Pembrolizumab was given as second-line (47.5%) or ≥ third-line therapy (52.5%). The objective response rate was 10% and 12.5% by Response Evaluation Criteria in Solid Tumor (RECIST) v1.1 and immune- modified RECIST (imRECIST) and median duration of response was 6.3 months. Among patients with progressive disease as best response, one patient (1/20, 5.0%) achieved complete response subsequently. The median progression-free survival (PFS) and overall survival (OS) were 1.5 months (95% confidence interval [CI], 0.0 to 3.0) and 4.3 months (95% CI, 3.5 to 5.1), respectively, and objective response per imRECIST was significantly associated with PFS (p < 0.001) and OS (p=0.001). Tumor proportion score ≥ 50% was significantly associated with higher response rates including the response after pseudoprogression (vs. < 50%; 37.5% vs. 6.5%; p=0.049).
Conclusion
Pembrolizumab showed modest anti-tumor activity in heavily pretreated PD-L1–positive BTC patients. In patients who showed objective response, durable response could be achieved.

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Validation of the 8th AJCC Cancer Staging System for Pancreas Neuroendocrine Tumors Using Korean Nationwide Surgery Database: Yunghun You, Jin-Young Jang, Song Cheol Kim, Yoo-Seok Yoon, Joon Seong Park, Chol Kyoon Cho, Sang-Jae Park, Jae Do Yang, Woo Jung Lee, Tae Ho Hong, Keun Soo Ahn, Chi-Young Jeong, Hyeon Kook Lee, Seung Eun Lee, Young Hoon Roh, Hee Joon Kim, Hongbeom Kim, In Woong Han; Cancer Res Treat. 2019;51(4):1639-1652. Published online April 19, 2019; DOI: https://doi.org/10.4143/crt.2019.023

Abstract PDF PubReader ePub

Purpose
The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic neuroendocrine tumor (PNET) included several significant changes. We aim to evaluate this staging system compared to the 7th edition AJCC staging system and European Neuroendocrine Tumors Society (ENETS) system.
Materials and Methods
We used Korean nationwide surgery database (2000-2014). Of 972 patients who had undergone surgery for PNET, excluding patients diagnosed with ENETS/World Health Organization 2010 grade 3 (G3), only 472 patients with accurate stage were included.
Results
Poor discrimination in overall survival rate (OSR) was noted between AJCC 8th stage III and IV (p=0.180). The disease-free survival (DFS) curves of 8th AJCC classification were well separated between all stages. Compared with stage I, the hazard ratio of II, III, and IV was 3.808, 13.928, and 30.618, respectively (p=0.007, p < 0.001, and p < 0.001). The curves of OSR and DFS of certain prognostic group in AJCC 7th and ENETS overlapped. In ENETS staging system, no significant difference in DFS between stage IIB versus IIIA (p=0.909) and IIIA versus IIIB (p=0.291). In multivariable analysis, lymphovascular invasion (p=0.002), perineural invasion (p=0.003), and grade (p < 0.001) were identified as independent prognostic factors for DFS.
Conclusion
This is the first large-scale validation of the AJCC 8th edition staging system for PNET. The revised 8th system provides better discrimination compared to that of the 7th edition and ENETS TNM system. This supports the clinical use of the system.

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Prognosis of Pancreatic Cancer Patients with Synchronous or Metachronous Malignancies from Other Organs Is Better than Those with Pancreatic Cancer Only: Su-Jin Shin, Hosub Park, You-Na Sung, Changhoon Yoo, Dae Wook Hwang, Jin-hong Park, Kyu-pyo Kim, Sang Soo Lee, Baek-Yeol Ryoo, Dong-Wan Seo, Song Cheol Kim, Seung-Mo Hong; Cancer Res Treat. 2018;50(4):1175-1185. Published online December 20, 2017; DOI: https://doi.org/10.4143/crt.2017.494

Abstract PDF Supplementary Material PubReader ePub

Purpose
Pancreatic cancer associated double primary tumors are rare and their clinicopathologic characteristics are not well elucidated.
Materials and Methods
Clinicopathologic factors of 1,352 primary pancreatic cancers with or without associated double primary tumors were evaluated.
Results
Of resected primary pancreatic cancers, 113 (8.4%) had associated double primary tumors, including 26 stomach, 25 colorectal, 18 lung, and 13 thyroid cancers. The median interval between the diagnoses of pancreatic cancer and associated double primary tumors was 0.5 months. Overall survival (OS) of pancreatic cancer patients with associated double primary tumors was longer than those with pancreatic cancer only (median, 23.1 months vs. 17.0 months, p=0.002). Patients whose pancreatic cancers were resected before the diagnosis of metachronous tumors had a better OS than patients whose pancreatic cancer resected after the diagnosis of metachronous tumors (48.9 months and 13.5 months, p=0.001) or those whose pancreatic cancers were resected synchronously with non-pancreas tumors (19.1 months, p=0.043). The OS of pancreatic cancer patients with stomach (33.9 months, p=0.032) and thyroid (117.8 months, p=0.049) cancers was significantly better than those with pancreas cancer only (17.0 months).
Conclusion
About 8% of resected pancreatic cancers had associated double primary tumors, and those from the colorectum, stomach, lung, and thyroid were common. Patients whose pancreatic cancer was resected before the diagnosis of metachronous tumors had better OS than those resected after the diagnosis of metachronous tumors or those resected synchronously.

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Prognostic Factors in Early Gastric Cancer: Song Cheol Kim, Yoon Seok Hur, Jin Pok Kim; J Korean Cancer Assoc. 1994;26(1):1-9.

Abstract PDF: A retrospective study of 797 cases of early gastric cancer(EGC) operated from 1981 to 199l at Seoul National University Hospital was performed to evaluate its prognostic factors for 9 clinicopathologic factors(sex, age, tumor location, gross type, histology, depth of invasion, lymph node metastasis, resection type). The incidence of EGC in gastric cancer was 20.l% and overall 5 year survival rate was 93%. In univariate and multivariate analysis af the above mentioned 9 factors, stastically significant prognostic factor was only regional lymph node metastasis(P<0.05). In addition, signet ring cell carcinoma was more prevalent in EGC(2.9 times) than in AGC and had a good prognosis than other histalogic type. In conclusion, extensive lymphadenectomy(R2 or R2+a) is needed only in AGC but also in EGC. And more extensive study on the prognostic factors of the signet ring cell carcinoma that has been considered as a poor prognostic type is further necessory to clarify the good effect in EGC and bad effect in AGC.

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Clincial Analysis of Gastric Cardia Cancer: Jin Pok Kim, Hwan Young Yoo, Song Cheol Kim, Han Kwang Yang; J Korean Cancer Assoc. 1994;26(3):361-369.

Abstract PDF: Gastric cardia cancers comprise gastric cancers which involve stomach of distal 2cm from gastroesophageal junction. It has been reported that cardia cancer has relatively poorer prog- nosis than gastric cancer of the other sites. To evaluate clinicopathological characteristics of gastric cardia cancer and to determine prognostic factors, we analyzed retrospectively 198 pa- tients who underwent operations for gastric cardia cancers between 1970 and l991 and had the following results. Gasric resection was performed in 176 patients. The ratio of gastric cardia cancer to gastric cancers of the other sites was slightly decreased in 1980s than in l970s (over- all 3.8% of gastric cancers). Gastric cardia cancer had poorer 5-year survival rate than those of gastric cancers of other sites (34.2% for cardia, 38.5% for fundus, 54.1% for body, 48.9% for an- trum). In cardia cancer, 2.5% was early gastric cancer, 89.3% had more than serosal invasion, 66. 5% had positive lymph node involvement and 75.2% were in stage III 4 IV. There was esophageal involvement in 33.5%; despite clear proximal resection mergin on frozen biopsies, there were positive resection margin of 21.4% (3/14) in cases with resection margin of less than 2 cm and 3.7% (6/162) in cases with resection margin of 2cm or more than 2cm (p<0.05, Fisher's exact test). These results suggest that the length of proximal resection margin should be at least 2 cm to get a cancer-free proximal resection margin in gastric cardia cancer. Multivariate analysis revealed that depth of invasion, length of proximal resection margin and lymph node metastasis were significant prognostic factors. We conclude that poorer prognosis of gastric cardia cancer is due to more advanced stage at the time of diagnosis. Therefore, to improve the survival of gastric cardia cancer, better means of early diagnosis should be developed.

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Clinicopathologic Analysis of Stage 4 Gastric Cancer: Song Cheol Kim, Han Kwang Yang, Kuhn Uk Lee, Kuk Jin Choe, Jin Pok Kim; J Korean Cancer Assoc. 1994;26(6):868-878.

Abstract PDF: A statistical analysis of 741 cases of stage IV gastric cancer patients diagnosed between 1987 and 1991 at Seoul National University Hospital was done to evaluate the clinicopathological features and to find a proper management of stage IV gastric cancer. Peritoneal metastais (PM) was present in 227 patients (31%), liver metastasis (LM) in 198 patients (29%), direct invasion to adjacent organ (DI) in 148 patients (20%), and synchronous peritoneal and liver metast sis in 62 patients (8%). Patients with peritoneal metastasis were younger, and have Borrmann type IV and signet rinacell type lesion more frequently. Patients with liver metastasis were loder, and have Borrman type I and II and moderately-differentiated, highly-located lesion more frequently. Two-year survival rate for patients with direct invasion (DI) group was 20.4%, 17.7% for patients with liver metastasis (LM), 6.9% for patients with pritoneal meatstasis (PM), and 4.2% for patients with synchronous liver and peritoneal metastasis. In the group of patients with direct invasion (DI), patients who received gastric resection have better survival time than the patients who recieved bypass procedure (450 days vs 202 days in median survival, P<0.05), althrough resected group shows less invasive than bypass group. There was significant survival gain in resected group when comparision was done in T4NZMO homogenized group. But there was no significant survival gain by resection in liver or peritoneal metastasis (P > 0.05). Two year survival rate of the patients who recieved gastrectomy was 34.0% in immunochemotherapy group (n=23), 23.4% in chemotheraPy group (n=33), and 13.5% in operation ony group (n=22)(P<0.05), where prognostic parameters of these aroups were relatively comparable. We conclude that in stage IV gastric cancer there were different clinicopathologic features according to the metastatic patterns and gastric resection has significant survival gain than bypass procedure in direct invasion group, although not in liver or peritoneal metastasis. This retrospective analysis suggested the possibility that postoperative immunochemotherapy or chemotherapy may have some role in treatment of stage IV gastric cancer.

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