Long-Term Outcomes of Anatomical and Biological Borderline Resectable Pancreatic Ductal Adenocarcinoma After Gemcitabine/S-1-Based Neoadjuvant Chemoradiotherapy
- 1Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City 5148507, Mie, Japan
Abstract
Background/Objectives: Oncological outcomes in borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) remain unclear. This long-term observational study evaluated these outcomes in patients with BR-PDAC treated with a consistent neoadjuvant chemoradiotherapy (CRT) regimen and explored host-related prognostic markers. Methods: We retrospectively analyzed 206 patients with PDAC who received neoadjuvant gemcitabine plus S-1 with concurrent radiotherapy between 2011 and 2022. Biological BR was defined as anatomically resectable disease with an initial carbohydrate antigen 19-9 (CA19-9) level ≥500 U/mL. Anatomical BR was subdivided into portal venous involvement (BR-PV) and arterial involvement (BR-A). Outcomes were compared according to resectability and surgical resection, with resectable (R) patients as a reference. Prognostic factors among resected BR patients were assessed using multivariable Cox regression analysis. Results: The median follow-up was 62.5 months. Resection rates were 85.7%, 83.3%, 69.8%, and 55.6% for R, biological BR, BR-PV, and BR-A, respectively. Although the resection rate of biological BR was similar to that of R, its survival did not differ significantly from that of anatomical BR. Across all BR subtypes, surgical resection was associated with longer overall survival. Among resected patients, the post-CRT neutrophil-lymphocyte-to-monocyte ratio (NL/M), a peripheral blood cell index, was associated with overall survival (hazard ratio 1.020, p = 0.009). Patients with a high post-CRT NL/M had poorer prognosis than those with a low NL/M (p = 0.001). Conclusions: Biological and anatomical BR-PDAC showed no significant difference in long-term survival after neoadjuvant CRT, and surgical resection was associated with longer survival across BR subtypes. Post-CRT NL/M was associated with overall survival after resection and may serve as a potential host-related prognostic marker, although further validation is needed.
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BibTeX
@article{komatsubara2026longterm,
title = {{Long-Term Outcomes of Anatomical and Biological Borderline Resectable Pancreatic Ductal Adenocarcinoma After Gemcitabine/S-1-Based Neoadjuvant Chemoradiotherapy}},
author = {Haruna Komatsubara and Shugo Mizuno and Daisuke Noguchi and Naohisa Kuriyama and Aoi Hayasaki and Yuki Segi and Kazuyuki Gyoten and Takahiro Ito and Yusuke Iizawa and Takehiro Fujii and Akihiro Tanemura and Yasuhiro Murata and Masashi Kishiwada},
journal = {Cancers},
year = {2026},
month = nov,
doi = {10.3390/cancers18213521},
url = {https://www.mdpi.com/2072-6694/18/21/3521},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Long-Term Outcomes of Anatomical and Biological Borderline Resectable Pancreatic Ductal Adenocarcinoma After Gemcitabine/S-1-Based Neoadjuvant Chemoradiotherapy
AU - Haruna Komatsubara
AU - Shugo Mizuno
AU - Daisuke Noguchi
AU - Naohisa Kuriyama
AU - Aoi Hayasaki
AU - Yuki Segi
AU - Kazuyuki Gyoten
AU - Takahiro Ito
AU - Yusuke Iizawa
AU - Takehiro Fujii
AU - Akihiro Tanemura
AU - Yasuhiro Murata
AU - Masashi Kishiwada
PY - 2026
DA - 2026/11/02
JO - Cancers
DO - 10.3390/cancers18213521
UR - https://www.mdpi.com/2072-6694/18/21/3521
AB - Background/Objectives: Oncological outcomes in borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) remain unclear. This long-term observational study evaluated these outcomes in patients with BR-PDAC treated with a consistent neoadjuvant chemoradiotherapy (CRT) regimen and explored host-related prognostic markers. Methods: We retrospectively analyzed 206 patients with PDAC who received neoadjuvant gemcitabine plus S-1 with concurrent radiotherapy between 2011 and 2022. Biological BR was defined as anatomically resectable disease with an initial carbohydrate antigen 19-9 (CA19-9) level ≥500 U/mL. Anatomical BR was subdivided into portal venous involvement (BR-PV) and arterial involvement (BR-A). Outcomes were compared according to resectability and surgical resection, with resectable (R) patients as a reference. Prognostic factors among resected BR patients were assessed using multivariable Cox regression analysis. Results: The median follow-up was 62.5 months. Resection rates were 85.7%, 83.3%, 69.8%, and 55.6% for R, biological BR, BR-PV, and BR-A, respectively. Although the resection rate of biological BR was similar to that of R, its survival did not differ significantly from that of anatomical BR. Across all BR subtypes, surgical resection was associated with longer overall survival. Among resected patients, the post-CRT neutrophil-lymphocyte-to-monocyte ratio (NL/M), a peripheral blood cell index, was associated with overall survival (hazard ratio 1.020, p = 0.009). Patients with a high post-CRT NL/M had poorer prognosis than those with a low NL/M (p = 0.001). Conclusions: Biological and anatomical BR-PDAC showed no significant difference in long-term survival after neoadjuvant CRT, and surgical resection was associated with longer survival across BR subtypes. Post-CRT NL/M was associated with overall survival after resection and may serve as a potential host-related prognostic marker, although further validation is needed.
SN - 2072-6694
ER -