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. 2025 Mar 4;9(4):830-841.
doi: 10.1002/ags3.70001. eCollection 2025 Jul.

Clinical role of intraperitoneal chemotherapy in patients with pancreatic ductal adenocarcinoma concomitant with occult peritoneal dissemination: A multicenter retrospective study

Tomohisa Yamamoto  1 , Toshio Shimokawa  2 , Masamichi Hayashi  3 , Masamichi Mizuma  4 , Katsuhisa Hirano  5 , Atsushi Oba  6 , Toshimichi Asano  7 , Hideyo Miyato  8 , Makoto Yoshida  9 , Ippei Matsumoto  10 , Yasunari Kawabata  11 , Katsunori Sakamoto  12 , Fuyuhiko Motoi  13 , Shigeto Ishii  14 , Yuki Homma  15 , Hiromitsu Maehira  16 , Yutaro Matsunaga  17 , Tetsuya Ikemoto  18 , Masafumi Nakamura  19 , Yuko Mataki  20 , Tsuyoshi Notake  21 , Keiichi Akahoshi  22 , Hideki Takami  3 , So Yamaki  1 , Daisuke Hashimoto  1 , Yasutoshi Kimura  23 , Satoshi Hirano  7 , Yosuke Inoue  6 , Tsutomu Fujii  5 , Michiaki Unno  4 , Yasuhiro Kodera  3 , Joji Kitayama  8 , Sohei Satoi  1   24 ; Study Group of Pancreatic Ductal Adenocarcinoma with Peritoneal Dissemination
Affiliations

Clinical role of intraperitoneal chemotherapy in patients with pancreatic ductal adenocarcinoma concomitant with occult peritoneal dissemination: A multicenter retrospective study

Tomohisa Yamamoto et al. Ann Gastroenterol Surg. .

Abstract

Background: The effectiveness of intraperitoneal chemotherapy using paclitaxel (i.p.-PTX) in pancreatic ductal adenocarcinoma (PDAC) patients with peritoneal dissemination remains elusive. The aim of this study is to investigate the clinical outcome of patients treated with i.p.-PTX combined with systemic chemotherapy compared with current standard chemotherapy including gemcitabine plus nab-paclitaxel and FOLFIRINOX.

Methods: Data of patients with peritoneal dissemination was retrospectively collected and analyzed (i.p.-PTX, n = 83; control, n = 86). Inverse probability of treatment-weighted analyses (IPTW) was used to balance baseline characteristics between two groups. Survival curves were estimated using Kaplan-Meier method, and the differences were compared using the log-rank test.

Results: No significant differences were noted in overall survival (14.9 vs. 15.5 months, p = 0.481) and progression free survival (9.5 vs. 9.1 months, p = 0.267) between i.p.-PTX and the control groups. Nevertheless, i.p.-PTX (9.9 months) significantly prolonged the median progression-free survival (PFS) time compared with the control (8.6 months), among the matched patients using IPTW (hazard ratio 0.666, p = 0.041). Moreover, subgroup analysis among the patients whose primary tumor were evaluated either as resectable or borderline resectable disease revealed significantly better overall survival in the i.p.-PTX group compared with the control group (21.3 vs. 14.7 months, hazard ratio; 0.532, p = 0.033). Conversion surgery was more frequently performed in the i.p.-PTX group than the control group (24% vs. 4%, p = 0.006).

Conclusion: The i.p. PTX regimen prolonged PFS but not overall survival, and subgroup analysis suggested the possibility of survival benefit in patients with occult peritoneal dissemination whose primary tumor was classified as resectable/borderline resectable disease.

Keywords: intraperitoneal chemotherapy; peritoneal dissemination.

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Conflict of interest statement

Satoi S discloses research funding from Nihon Servier and Amino‐up Co. Motoi F received honoraria and scholarship from Taiho pharma co. Nakamura M disclose research funding from Taiho pharma co. Unno M disclose research funding from Taiho pharma co. Fujii T serves as an associate editor for Annals of Gastroenterological Surgery. Kodera Y received payment or honoraria from Taiho pharma co, Eli Lilly Japan K.K., and Pfizer Japan Inc., and serves as an associate editor for Annals of Gastroenterological Surgery.

Figures

FIGURE 1
FIGURE 1
Flowchart of patient selection. PDAC, pancreatic ductal adenocarcinoma, GEM, gemcitabine, i.p., intraperitoneal, PTX, paclitaxel, GnP, gemcitabine plus nab‐paclitaxel, (m)FFX, modified FOLFIRINOX.
FIGURE 2
FIGURE 2
Survival analysis before and after IPTW. Kaplan–Meier curves show (A) overall survival before IPTW, (B) progression‐free survival before IPTW, (C) overall survival after IPTW, and (D) progression‐free survival after IPTW. HR, hazard ratio, IPTW, inverse probability of treatment weighting, i.p.‐PTX, intraperitoneal paclitaxel, MST, median survival time.
FIGURE 3
FIGURE 3
Forest plot of overall survival in subgroups of the entire cohort. CI, confidence interval, i.p.‐PTX, intraperitoneal paclitaxel, mGPS, modified Glasgow prognostic score, NCCN, National Comprehensive Cancer Network, Pbt; pancreas body and tail, Ph, pancreas head, PNI, Prognostic Nutritional Index, PS, performance status, R/BR, resectable/borderline resectable, UR, unresectable. Treatment period means duration from the date starting first‐line chemotherapy to the date of the final administration of the anticancer drug.
FIGURE 4
FIGURE 4
Survival analysis of patients with resectable/borderline resectable disease after IPTW. HR, hazard ratio, IPTW, inverse probability of treatment weighting, i.p.‐PTX, intraperitoneal paclitaxel, MST, median survival time, R/BR, resectable/borderline resectable.
FIGURE 5
FIGURE 5
Survival analysis by surgery status. Overall survival from initial treatment. Chemo, chemotherapy, CS, conversion surgery, HR, hazard ratio, MST, median survival time.
See this image and copyright information in PMC

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