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Updated: Jun 6, 2026
DIPLOMA Approach for Standardized Pathology Assessment of Distal Pancreatectomy Specimens
Published on: February 1, 2020
Conversion and resection rates in borderline resectable and locally advanced pancreatic cancer following neoadjuvant
Ali H Aljubran1, Maaz Kamal Alata2, Ahmed Ali Badran1,3
1Medical Oncology Department, Cancer Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Background:
Neoadjuvant therapy (NAT) may improve resectability and survival in borderline resectable and locally advanced unresectable pancreatic ductal adenocarcinoma (PDAC). However, the outcomes, biomarker utility, and the impact of NAT regimens remain understudied.
Methods:
Retrospective analysis of PDAC patients (2004-2018) from three tertiary centers in Saudi Arabia. Patients who were deemed unresectable or borderline resectable at initial presentation. Analyzed variables included demographics, tumor characteristics (location, stage), NAC regimens (FOLFIRINOX, GEMCAP, gemcitabine monotherapy), response to therapy (RECIST criteria), surgical outcomes (resection rate, R0 resection), CA19-9 levels, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and survival outcomes (overall survival (OS) and progression-free survival (PFS)).
Results:
Thirty-nine patients were eligible for the study. Median age was 60 years (range: 29-79 years). The study population mainly consisted of male patients (25/39, 64%). The majority (30/39, 80%) had a good performance status (ECOG PS 0-1). Most patients (30/39, 77%) in the head of pancreas, while the remainder (8/39) had it in the body or tail., Following neoadjuvant chemotherapy, 31% of patients (12/39) had surgical resection. R0 resection was accomplished in 33% of those patients (4/12). Surgery was associated with significantly improved median progression-free survival (PFS) compared to no surgery (19.6 vs 5.8 months; p=0.008). Certain factors, including poorer performance status, elevated CA19-9 levels, high NLR and PLR, and weight loss, were associated with worse PFS and OS in univariate analysis; however, these findings were not statistically significant. Multivariate analysis also suggested numerical differences in PFS and OS based on these factors, but the limited sample size likely prevented statistical significance.
Conclusions:
NAT facilitates resection in approximately one-third of initially unresectable PDAC cases, with a significant improvement in PFS for patients undergoing subsequent surgery. Elevated pre-treatment CA19-9, NLR, and PLR may identify patients less likely to benefit from NAC. Biomarker-driven trials are warranted to optimize patient selection and personalize treatment strategies, especially in resource-constrained settings.