Optimal Preoperative Multidisciplinary Treatment in Borderline Resectable Pancreatic Cancer

Abstract

<i>Background:</i> The objective of this study was to investigate the optimal neoadjuvant therapy (NAT) for borderline resectable pancreatic cancer invading the portal vein (BR-PV) or abutting major arteries (BR-A). <i>Methods:</i> We retrospectively analyzed 88 patients with BR-PV and 111 patients with BR-A. <i>Results:</i> In BR-PV patients who underwent upfront surgery (<i>n</i> = 46)/NAT (<i>n</i> = 42), survival was significantly better in the NAT group (3-year overall survival (OS): 5.8%/35.5%, <i>p</i> = 0.004). In BR-A patients who underwent upfront surgery (<i>n</i> = 48)/NAT (<i>n</i> = 63), survival was also significantly better in the NAT group (3-year OS:15.5%/41.7%, <i>p</i> < 0.001). The prognosis tended to be better in patients who received newer chemotherapeutic regimens, such as FOLFIRINOX and gemcitabine with nab-paclitaxel. In 36 BR-PV patients who underwent surgery after NAT, univariate analysis revealed that normalization of tumor marker (TM) levels (<i>p</i> = 0.028) and preoperative high prognostic nutritional index (PNI) (<i>p</i> = 0.022) were significantly associated with a favorable prognosis. In 39 BR-A patients who underwent surgery after NAT, multivariate analysis revealed that preoperative PNI > 42.5 was an independent prognostic factor (HR: 0.15, <i>p</i> = 0.014). <i>Conclusions:</i> NAT using newer chemotherapy is essential for improving the prognosis of BR pancreatic cancer. These findings suggest that prognosis may be prolonged by maintaining good nutritional status during preoperative treatment.