
==== Front
Ann Surg Oncol
Ann Surg Oncol
Annals of Surgical Oncology
1068-9265
1534-4681
Springer International Publishing Cham

39020113
15853
10.1245/s10434-024-15853-1
ASO Author Reflections
ASO Author Reflections: Importance of Preoperative Prediction of Survival in Resectable Pancreatic Ductal Adenocarcinoma
Konishi Takanori MD, PhD
Takano Shigetsugu MD, PhD
Ohtsuka Masayuki MD, PhD otsuka-m@faculty.chiba-u.jp

https://ror.org/01hjzeq58 grid.136304.3 0000 0004 0370 1101 Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
17 7 2024
17 7 2024
2024
31 10 70747075
27 6 2024
27 6 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by/4.0/ Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
issue-copyright-statement© Society of Surgical Oncology 2024
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pmcPast

Multidisciplinary treatment is crucial to prolong the survival of patients with pancreatic ductal adenocarcinoma (PDAC). Adjuvant chemotherapy has been highly established; however, the efficacy of neoadjuvant therapy for resectable PDAC remains controversial.1,2 The Prep-02/JSAP-05 trial revealed the survival benefits of neoadjuvant chemotherapy with gemcitabine and S-1 for resectable PDAC.3 Conversely, effect of neoadjuvant therapy could differ according to the disease progression,4 and optimal candidates of neoadjuvant therapy for resectable PDAC have not been well determined. Survival prediction upon diagnosis may help determine the treatment strategy for resectable PDAC. To date, previous studies have revealed several clinical factors that are associated with patient’s survival. However, no single preoperative marker is sufficient to accurately predict postoperative survival for resectable PDAC.

Present

In the current study,5 we retrospectively analyzed the oncological outcome of patients with resectable PDAC who underwent upfront surgery with planned adjuvant chemotherapy. In this cohort, 24.9% of the patients did not have tumor recurrence within 5 years after upfront surgery and 5-year overall survival rate was 33.3%. Multivariate analyses revealed that tumor diameter in computed tomography ≤ 19 mm, s-pancreas-1 antigen (span-1) ≤ 30 U/ml, prognostic nutritional index (PNI) ≥ 44.31, and lymphocyte-to-monocyte ratio (LMR) ≥ 3.79 were independent prognostic factors for preferable overall survival. A prognostic prediction model was developed on the basis of the four preoperative prognostic factors for the accurate prediction of long-term survival before treatment. This model extracted the patient’s cohort who experienced good oncological outcomes with a 5-year overall survival rate of 82.4% even without neoadjuvant therapy. This study indicated that anatomical, biological, nutritional, and inflammatory factors evaluation improve the quality of prognostic prediction before treatment and may be valuable for introducing an ideal multidisciplinary treatment for resectable PDAC.

Future

The clinical benefits of neoadjuvant therapy for resectable PDAC need to be further clarified. In addition, future research should focus on optimal candidates for neoadjuvant therapy as well as the ideal regimen or duration of neoadjuvant therapy for resectable PDAC. The effect of neoadjuvant therapy on survival is theoretically minimal for patients having long-term survival after upfront surgery with adjuvant therapy; thus, the accurate survival prediction before treatment will facilitate the decision-making process for providing neoadjuvant therapy for patients with resectable PDAC. Validating our results in a prospective study with larger cohort of patients is warranted in the future for the clinical use of the prognostic prediction model in this study. In addition, the effect of neoadjuvant therapy on the oncological outcomes after pancreatectomy according to the prognostic prediction model should be clarified.

Disclosure

There are no conflicts of interest.

This article refers to: Konishi T, Takano S, Takayashiki T et al. Preoperative prediction of long-term survival after surgery in patients with resectable pancreatic ductal adenocarcinoma. Ann Surg Oncol. (2024). 10.1245/s10434-024-15648-4

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