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Multicenter Study
. 2025 Jan;32(1):69-81.
doi: 10.1002/jhbp.12074. Epub 2024 Sep 24.

Optimal treatment strategy for patients with pancreatic cancer having positive peritoneal cytology: A nationwide multicenter retrospective cohort study supervised by the Japanese Society of Hepato-Biliary-Pancreatic Surgery

Kyohei Ariake  1   2 , Masamichi Mizuma  1 , Michiaki Unno  1 , Sohei Satoi  3 , Naoto Yamamoto  4 , Masamichi Hayashi  5 , Manabu Kawai  6 , Hirofumi Akita  7 , Eiji Toyoda  8 , Tsutomu Fujii  9 , Masaru Sasaki  10 , Kenichi Hakamada  11 , Jota Watanabe  12 , Etsuro Hatano  13 , Masaaki Hidaka  14 , Satoshi Hirano  15 , Hiroshi Kurahara  16 , Ippei Matsumoto  17 , Goro Honda  18 , Toshiro Ogura  19 , Masafumi Nakamura  20   21 , Itaru Endo  21   22
Affiliations
Multicenter Study

Optimal treatment strategy for patients with pancreatic cancer having positive peritoneal cytology: A nationwide multicenter retrospective cohort study supervised by the Japanese Society of Hepato-Biliary-Pancreatic Surgery

Kyohei Ariake et al. J Hepatobiliary Pancreat Sci. 2025 Jan.

Abstract

Background: The aim of this study was to determine the optimal treatment for patients with pancreatic cancer (PaCa) having positive peritoneal cytology (PPC).

Methods: This multicenter retrospective study included patients with PPC treated at 78 high-volume centers between January 2012 and December 2020. Prognoses after resection (S-group) and initiation of nonsurgical treatment (N-group) were compared. Prognostic factors for survival in both groups were analyzed. Detailed characteristics of conversion surgery (CS) in the N-group were evaluated.

Results: In total, 568 enrolled patients were classified into an S-group (n = 445) or an N-group (n = 123). Median survival times (MSTs) were 19.0 months and 19.3 months, respectively, with no significant difference in prognosis (p = .845). The intervenable prognostic factors for survival were adjuvant treatment in the S-group (p < .001) and CS in the N-group (p < .001). Following CS, the MST was prolonged to 45.6 months, and peritoneal or liver recurrence decreased considerably. CS can be expected if PPC is diagnosed before neoadjuvant treatment and when combination treatment is initiated.

Conclusion: Surgical resection may not be beneficial for improving survival when PPC is evident. Chemotherapy aiming for CS may be the optimal treatment for such patients.

Keywords: chemotherapy; conversion surgery; pancreatic cancer; peritoneal cytology.

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Conflict of interest statement

The authors declare no conflict of interest for this article.

Figures

FIGURE 1
FIGURE 1
Flow chart of patients included in the study cohort.
FIGURE 2
FIGURE 2
Kaplan–Meier curves of OS. (a) Comparison of OS in patients with PPC in the total cohort. Patients treated with surgical resection (S‐group, n = 445) or nonsurgical treatment (N‐group, n = 123) are represented in red and blue, respectively. The 1‐, 2‐, 3‐, and 5‐year survival rates were 68.7%, 39.9%, 24.8%, and 12.0%, respectively, in the S‐group and 76.1%, 39.7%, 25.9%, and 6.8%, respectively, in the N‐group. (b) Comparison of OS in patients with PPC after propensity score matching. Patients treated with surgical resection (n = 89) or nonsurgical treatment (n = 89) are represented in red and blue, respectively. OS was calculated from the date of PPC diagnosis to the date of death or censoring. MST, median survival time; OS, overall survival; PPC, positive peritoneal cytology.
See this image and copyright information in PMC

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