title: Gemcitabine-based chemoradiotherapy followed by surgery for borderline resectable and locally unresectable pancreatic ductal adenocarcinoma: significance of the CA19-9 reduction rate and intratumoral human equilibrative nucleoside transporter 1 expression.
abstract: OBJECTIVE
  This study aimed to evaluate the efficacy of gemcitabine-based chemoradiotherapy followed by surgery (gem-CRTS) for pancreatic ductal adenocarcinoma (PDAC) for borderline resectable (BR) and locally unresectable (UR) tumors.
  
  
  METHODS
  One hundred patients with PDAC who underwent the gem-CRTS protocol were classified into 3 groups, namely, resectable (R; 14), BR (44), and UR (42). After chemoradiotherapy, the patients were reassessed for curative-intent resection.
  
  
  RESULTS
  At reassessment, distant metastases became apparent in 27% of R patients, in 12% of BR patients, and in 18% of UR patients. The multivariate analysis of preoperative factors indicated that the CA19-9 reduction rate was an independent prognostic factor in the BR group. Among reassessed patients, the resection rate was 63.6% in R, 83.7% in BR, and 50.0% in UR patients. In 63 patients that underwent curative-intent resection, the 3-year survival rate was 83.3% in R, 33.0% in BR, and 7.8% in UR patients. Using multivariate analysis, the independent prognostic factor was found to be the surgical margin in BR patients and human equilibrative nucleoside transporter 1 expression in UR patients.
  
  
  CONCLUSIONS
  We consider that our gem-CRTS protocol, even for locally UR PDAC, allows for the identification of candidates for aggressive resection at the time of reassessment and improved prognosis in the patients with positive human equilibrative nucleoside transporter 1 expression.
authors.affiliation: From the Departments of *Hepatobiliary Pancreatic and Transplant Surgery, †Radiology, ‡Gastroenterology and Hepatology, and §Pathology, and ∥Translational Medical Science, Mie University School of Medicine, Mie, Japan.
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Shugo
authors.initials: S
authors.lastname: Mizuno
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Murata
authors.forename: Masashi
authors.initials: M
authors.lastname: Kishiwada
authors.forename: Masanobu
authors.initials: M
authors.lastname: Usui
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakurai
authors.forename: Masami
authors.initials: M
authors.lastname: Tabata
authors.forename: Noriko
authors.initials: N
authors.lastname: Ii
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yamakado
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Inoue
authors.forename: Taizo
authors.initials: T
authors.lastname: Shiraishi
authors.forename: Tomomi
authors.initials: T
authors.lastname: Yamada
authors.forename: Shuji
authors.initials: S
authors.lastname: Isaji
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery / Q000628:therapy*; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D018395:CA-19-9 Antigen / Q000032:analysis; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D033721:Equilibrative Nucleoside Transporter 1 / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010179:Pancreas / Q000187:drug effects / Q000528:radiation effects / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D018395:CA-19-9 Antigen; D033721:Equilibrative Nucleoside Transporter 1; C438649:SLC29A1 protein, human; D003841:Deoxycytidine; D000093542:Gemcitabine