Consensus Statement on Mandatory Measurements for Pancreatic Cancer Trials for Patients With Resectable or Borderline Resectable Disease (COMM-PACT-RB): A Systematic Review and Delphi Consensus Statement | Cancer Biomarkers | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Consensus Statement on Mandatory Measurements for Pancreatic Cancer Trials for Patients With Resectable or Borderline Resectable Disease (COMM-PACT-RB)A Systematic Review and Delphi Consensus Statement

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Abstract

Importance  Pancreatic cancer is the third most common cause of cancer death; however, randomized clinical trials (RCTs) of survival in patients with resectable pancreatic cancer lack mandatory measures for reporting baseline and prognostic factors, which hampers comparisons between outcome measures.

Objective  To develop a consensus on baseline and prognostic factors to be used as mandatory measurements in RCTs of resectable and borderline resectable pancreatic cancer.

Evidence Review  We performed a systematic literature search of the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Embase for RCTs on resectable and borderline resectable pancreatic cancer with overall survival as the primary outcome. We produced a systematic summary of all baseline and prognostic factors identified in the RCTs. A Delphi panel that included 13 experts was surveyed to reach a consensus on mandatory and recommended baseline and prognostic factors.

Findings  The 42 RCTs that met inclusion criteria reported a total of 60 baseline and 19 prognostic factors. After 2 Delphi rounds, agreement was reached on 50 mandatory baseline and 20 mandatory prognostic factors for future RCTs, with a distinction between studies of neoadjuvant vs adjuvant treatment.

Conclusion and Relevance  This findings of this systematic review and international expert consensus have produced this Consensus Statement on Mandatory Measurements in Pancreatic Cancer Trials for Resectable and Borderline Resectable Disease (COMM-PACT-RB). The baseline and prognostic factors comprising the mandatory measures will facilitate better comparison across RCTs and eventually will enable improved clinical practice among patients with resectable and borderline resectable pancreatic cancer.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: October 27, 2021.

Published Online: April 21, 2022. doi:10.1001/jamaoncol.2022.0168

Corresponding Authors: Hanneke W. M. van Laarhoven, MD, PhD, Department of Medical Oncology, Cancer Center, Amsterdam UMC, University of Amsterdam, Amsterdam Meibergdreef 9, Room D3-221.1, Amsterdam 1105 AZ, The Netherlands (h.vanlaarhoven@amsterdamumc.nl).

Author Contributions: Prof van Laarhoven had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Profs Besselink, Wilmink, and van Laarhoven contributed equally as last authors.

Concept and design: Pijnappel, Suurmeijer, Groot Koerkamp, Ghaneh, van Eijck, Büchler, Wilmink, van Laarhoven.

Acquisition, analysis, or interpretation of data: Pijnappel, Suurmeijer, Kos, Siveke, Salvia, Ghaneh, van Etten-Jamaludin, Abrams, Brasiuniene, Casadei, Van Laethem, Berlin, Boku, Conroy, Golcher, Sinn, Neoptolemos, van Tienhoven, Besselink, Wilmink, van Laarhoven.

Drafting of the manuscript: Pijnappel, Kos, van Etten-Jamaludin, van Laarhoven.

Critical revision of the manuscript for important intellectual content: Pijnappel, Suurmeijer, Groot Koerkamp, Kos, Siveke, Salvia, Ghaneh, van Eijck, Abrams, Brasiuniene, Büchler, Casadei, Van Laethem, Berlin, Boku, Conroy, Golcher, Sinn, Neoptolemos, van Tienhoven, Besselink, Wilmink, van Laarhoven.

Statistical analysis: Pijnappel, Kos.

Administrative, technical, or material support: Suurmeijer, Conroy, Sinn, Besselink.

Supervision: Groot Koerkamp, Salvia, Ghaneh, van Eijck, Büchler, Casadei, Boku, Wilmink, van Laarhoven.

Other—Expert in the Delphi consensus writing, review, and editing: Conroy.

Conflict of Interest Disclosures: Prof Siveke reported grants from Bristol Myers Squibb, Celgene, Roche, Immunocore, Novartis, Shire, Bayer, Baxalta, AstraZeneca, and Servier; equity in itheranostics and Pharma15; and serving as a board member for Pharma15, all outside the submitted work. Dr Brasiūnienė reported personal fees for speaking engagements, consulting, and travel expenses from Roche, Eli Lilly, Ipsen, and Servier, all outside the submitted work. Dr Berlin reported personal fees from Ipsen, Bayer, Mirati, Clovis, Seagen, QED Therapeutics, and EMD Serono; grants for clinical trials from EMD Serono, Bristol Myers Squibb, Novartis, Immunomedics, Dragonfly, Boston Biomedical, Symphogen, I-Mab, Karyopharm, Pfizer, and Astellas; and personal fees from Novocure, Karyopharm, and Pancreatic Cancer Action Network, all outside the submitted work. Dr Boku reported grants from Ono and Takeda and personal fees from Taiho, Ono, and Bristol Myers Squibb, all outside the submitted work. Dr Sinn reported personal fees from Amgen, AstraZeneca, Sanofi, Servier, Merck Sharp & Dohme, Bristol Myers Squibb, Incyte, Pfizer, and Pierre Fabre outside the submitted work. Prof Neoptolemos reported grants from Heidelberger Stiftung Chirurgie, Dietmar Hopp Stiftung, and Stiftung Deutsche Krebshilfe outside the submitted work. Dr Wilmink reported grants from Novartis and Servier and nonfinancial support from Merck, Nordic, Celgene, and Servier, all outside the submitted work. Prof van Laarhoven reported grants, personal fees, and/or nonfinancial support from Bristol Myers Squibb, Bayer, Eli Lilly, Dragonfly, Celgene, Janssen, Incyte, Merck, Nordic Pharma, Roche, Servier; and grants from Philips, all outside the submitted work. No other disclosures were reported.

References
1.
Carrato  A , Falcone  A , Ducreux  M ,  et al.  A systematic review of the burden of pancreatic cancer in Europe: real-world impact on survival, quality of life and costs.   J Gastrointest Cancer. 2015;46(3):201-211. doi:10.1007/s12029-015-9724-1 PubMedGoogle ScholarCrossref
2.
McGuigan  A , Kelly  P , Turkington  RC , Jones  C , Coleman  HG , McCain  RS .  Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes.   World J Gastroenterol. 2018;24(43):4846-4861. doi:10.3748/wjg.v24.i43.4846 PubMedGoogle ScholarCrossref
3.
Bradley  A , Van der Meer  R , McKay  CJ .  A prognostic Bayesian network that makes personalized predictions of poor prognostic outcome post resection of pancreatic ductal adenocarcinoma.   PLoS One. 2019;14(9):e0222270. doi:10.1371/journal.pone.0222270 PubMedGoogle ScholarCrossref
4.
Henselmans  I , van Laarhoven  HWM , de Haes  HCJM ,  et al.  Training for medical oncologists on shared decision-making about palliative chemotherapy: a randomized controlled trial.   Oncologist. 2019;24(2):259-265. doi:10.1634/theoncologist.2018-0090 PubMedGoogle ScholarCrossref
5.
Clark  GM , Zborowski  DM , Culbertson  JL ,  et al.  Clinical utility of epidermal growth factor receptor expression for selecting patients with advanced non-small cell lung cancer for treatment with erlotinib.   J Thorac Oncol. 2006;1(8):837-846. doi:10.1016/S1556-0864(15)30414-7 PubMedGoogle ScholarCrossref
6.
Le  N , Sund  M , Vinci  A ; GEMS collaborating group of Pancreas 2000.  Prognostic and predictive markers in pancreatic adenocarcinoma.   Dig Liver Dis. 2016;48(3):223-230. doi:10.1016/j.dld.2015.11.001 PubMedGoogle ScholarCrossref
7.
Bradley  A , Van Der Meer  R , McKay  CJ .  A systematic review of methodological quality of model development studies predicting prognostic outcome for resectable pancreatic cancer.   BMJ Open. 2019;9(8):e027192. doi:10.1136/bmjopen-2018-027192 PubMedGoogle ScholarCrossref
8.
Lewis  RS  Jr , Vollmer  CM  Jr .  Risk scores and prognostic models in surgery: pancreas resection as a paradigm.   Curr Probl Surg. 2012;49(12):731-795. doi:10.1067/j.cpsurg.2012.08.002 PubMedGoogle ScholarCrossref
9.
Ter Veer  E , van Rijssen  LB , Besselink  MG ,  et al.  Consensus statement on mandatory measurements in pancreatic cancer trials (COMM-PACT) for systemic treatment of unresectable disease.   Lancet Oncol. 2018;19(3):e151-e160. doi:10.1016/S1470-2045(18)30098-6 PubMedGoogle ScholarCrossref
10.
Pijnappel  EN , Suurmeijer  JA , Groot Koerkamp  B ,  et al. Mandatory reporting measurements in trials for potentially resectable pancreatic cancer. In: Søreide  K , Stättner  S , eds.  Textbook of Pancreatic Cancer: Principles and Practice of Surgical Oncology. Springer; 2021:107-118. doi:10.1007/978-3-030-53786-9_8
11.
Tempero  MA , Malafa  MP , Chiorean  EG ,  et al.  Pancreatic adenocarcinoma, version 1.2019.   J Natl Compr Canc Netw. 2019;17(3):202-210. doi:10.6004/jnccn.2019.0014 PubMedGoogle ScholarCrossref
12.
Ter Veer  E , van Kleef  JJ , Schokker  S ,  et al.  Prognostic and predictive factors for overall survival in metastatic oesophagogastric cancer: a systematic review and meta-analysis.   Eur J Cancer. 2018;103:214-226. doi:10.1016/j.ejca.2018.07.132 PubMedGoogle ScholarCrossref
13.
Abrams  RA , Winter  KA , Regine  WF ,  et al.  Failure to adhere to protocol specified radiation therapy guidelines was associated with decreased survival in RTOG 9704—a phase III trial of adjuvant chemotherapy and chemoradiotherapy for patients with resected adenocarcinoma of the pancreas.   Int J Radiat Oncol Biol Phys. 2012;82(2):809-816. doi:10.1016/j.ijrobp.2010.11.039 PubMedGoogle ScholarCrossref
14.
Caprotti  R , Brivio  F , Fumagalli  L ,  et al.  Free-from-progression period and overall short preoperative immunotherapy with IL-2 increases the survival of pancreatic cancer patients treated with macroscopically radical surgery.   Anticancer Res. 2008;28(3B):1951-1954.PubMedGoogle Scholar
15.
Casadei  R , Di Marco  M , Ricci  C ,  et al.  Neoadjuvant chemoradiotherapy and surgery versus surgery alone in resectable pancreatic cancer: a single-center prospective, randomized, controlled trial which failed to achieve accrual targets.   J Gastrointest Surg. 2015;19(10):1802-1812. doi:10.1007/s11605-015-2890-4 PubMedGoogle ScholarCrossref
16.
Conroy  T , Hammel  P , Hebbar  M ,  et al; Canadian Cancer Trials Group, Unicancer-GI–PRODIGE Group.  Folfirinox or gemcitabine as adjuvant therapy for pancreatic cancer.   N Engl J Med. 2018;379(25):2395-2406. doi:10.1056/NEJMoa1809775 PubMedGoogle ScholarCrossref
17.
Farnell  MB , Pearson  RK , Sarr  MG ,  et al; Pancreas Cancer Working Group.  A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma.   Surgery. 2005;138(4):618-628. doi:10.1016/j.surg.2005.06.044 PubMedGoogle ScholarCrossref
18.
Gall  TM , Jacob  J , Frampton  AE ,  et al.  Reduced dissemination of circulating tumor cells with no-touch isolation surgical technique in patients with pancreatic cancer.   JAMA Surg. 2014;149(5):482-485. doi:10.1001/jamasurg.2013.3643 PubMedGoogle ScholarCrossref
19.
Golcher  H , Brunner  TB , Witzigmann  H ,  et al.  Neoadjuvant chemoradiation therapy with gemcitabine/cisplatin and surgery versus immediate surgery in resectable pancreatic cancer: results of the first prospective randomized phase II trial.   Strahlenther Onkol. 2015;191(1):7-16. doi:10.1007/s00066-014-0737-7 PubMedGoogle ScholarCrossref
20.
Hagiwara  Y , Ohashi  Y , Uesaka  K ,  et al; JASPAC 01 Study Group.  Health-related quality of life of adjuvant chemotherapy with S-1 versus gemcitabine for resected pancreatic cancer: results from a randomised phase III trial (JASPAC 01).   Eur J Cancer. 2018;93:79-88. doi:10.1016/j.ejca.2018.01.081 PubMedGoogle ScholarCrossref
21.
Ignjatovic  I , Knezevic  S , Knezevic  D ,  et al.  Standard versus extended lymphadenectomy in radical surgical treatment for pancreatic head carcinoma.   J BUON. 2017;22(1):232-238.PubMedGoogle Scholar
22.
Jang  JY , Han  Y , Lee  H ,  et al.  Oncological benefits of neoadjuvant chemoradiation with gemcitabine versus upfront surgery in patients with borderline resectable pancreatic cancer: a prospective, randomized, open-label, multicenter phase 2/3 trial.   Ann Surg. 2018;268(2):215-222. doi:10.1097/SLA.0000000000002705 PubMedGoogle ScholarCrossref
23.
Jang  JY , Kang  JS , Han  Y ,  et al.  Long-term outcomes and recurrence patterns of standard versus extended pancreatectomy for pancreatic head cancer: a multicenter prospective randomized controlled study.   J Hepatobiliary Pancreat Sci. 2017;24(7):426-433. doi:10.1002/jhbp.465 PubMedGoogle ScholarCrossref
24.
Jang  JY , Kang  MJ , Heo  JS ,  et al.  A prospective randomized controlled study comparing outcomes of standard resection and extended resection, including dissection of the nerve plexus and various lymph nodes, in patients with pancreatic head cancer.   Ann Surg. 2014;259(4):656-664. doi:10.1097/SLA.0000000000000384 PubMedGoogle ScholarCrossref
25.
Lygidakis  NJ , Sgourakis  G , Georgia  D , Vlachos  L , Raptis  S .  Regional targeting chemoimmunotherapy in patients undergoing pancreatic resection in an advanced stage of their disease: a prospective randomized study.   Ann Surg. 2002;236(6):806-813. doi:10.1097/00000658-200212000-00013 PubMedGoogle ScholarCrossref
26.
Neoptolemos  JP , Palmer  DH , Ghaneh  P ,  et al; European Study Group for Pancreatic Cancer.  Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial.   Lancet. 2017;389(10073):1011-1024. doi:10.1016/S0140-6736(16)32409-6 PubMedGoogle ScholarCrossref
27.
Neoptolemos  JP , Stocken  DD , Bassi  C ,  et al; European Study Group for Pancreatic Cancer.  Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial.   JAMA. 2010;304(10):1073-1081. doi:10.1001/jama.2010.1275 PubMedGoogle ScholarCrossref
28.
Nimura  Y , Nagino  M , Takao  S ,  et al.  Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas: long-term results of a Japanese multicenter randomized controlled trial.   J Hepatobiliary Pancreat Sci. 2012;19(3):230-241. doi:10.1007/s00534-011-0466-6 PubMedGoogle ScholarCrossref
29.
Oettle  H , Neuhaus  P , Hochhaus  A ,  et al.  Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial.   JAMA. 2013;310(14):1473-1481. doi:10.1001/jama.2013.279201 PubMedGoogle ScholarCrossref
30.
Oettle  H , Post  S , Neuhaus  P ,  et al.  Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial.   JAMA. 2007;297(3):267-277. doi:10.1001/jama.297.3.267 PubMedGoogle ScholarCrossref
31.
Berlin  JD , Feng  Y , Catalano  P ,  et al.  An intergroup randomized phase ii study of bevacizumab or cetuximab in combination with gemcitabine and in combination with chemoradiation in patients with resected pancreatic carcinoma: a trial of the ECOG-ACRIN Cancer Research Group (E2204).   Oncology. 2018;94(1):39-46. doi:10.1159/000480295 PubMedGoogle ScholarCrossref
32.
Regine  WF , Winter  KA , Abrams  R ,  et al.  Fluorouracil-based chemoradiation with either gemcitabine or fluorouracil chemotherapy after resection of pancreatic adenocarcinoma: 5-year analysis of the U.S. Intergroup/RTOG 9704 phase III trial.   Ann Surg Oncol. 2011;18(5):1319-1326. doi:10.1245/s10434-011-1630-6 PubMedGoogle ScholarCrossref
33.
Regine  WF , Winter  KA , Abrams  RA ,  et al.  Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial.   JAMA. 2008;299(9):1019-1026. doi:10.1001/jama.299.9.1019 PubMedGoogle ScholarCrossref
34.
Reni  M , Balzano  G , Aprile  G ,  et al.  Adjuvant PEFG (cisplatin, epirubicin, 5-fluorouracil, gemcitabine) or gemcitabine followed by chemoradiation in pancreatic cancer: a randomized phase II trial.   Ann Surg Oncol. 2012;19(7):2256-2263. doi:10.1245/s10434-011-2205-2 PubMedGoogle ScholarCrossref
35.
Reni  M , Balzano  G , Zanon  S ,  et al.  Safety and efficacy of preoperative or postoperative chemotherapy for resectable pancreatic adenocarcinoma (PACT-15): a randomised, open-label, phase 2-3 trial.   Lancet Gastroenterol Hepatol. 2018;3(6):413-423. doi:10.1016/S2468-1253(18)30081-5 PubMedGoogle ScholarCrossref
36.
Schmidt  J , Abel  U , Debus  J ,  et al.  Open-label, multicenter, randomized phase III trial of adjuvant chemoradiation plus interferon Alfa-2b versus fluorouracil and folinic acid for patients with resected pancreatic adenocarcinoma.   J Clin Oncol. 2012;30(33):4077-4083. doi:10.1200/JCO.2011.38.2960 PubMedGoogle ScholarCrossref
37.
Shimoda  M , Kubota  K , Shimizu  T , Katoh  M .  Randomized clinical trial of adjuvant chemotherapy with S-1 versus gemcitabine after pancreatic cancer resection.   Br J Surg. 2015;102(7):746-754. doi:10.1002/bjs.9775 PubMedGoogle ScholarCrossref
38.
Sinn  M , Bahra  M , Liersch  T ,  et al.  CONKO-005: adjuvant chemotherapy with gemcitabine plus erlotinib versus gemcitabine alone in patients after R0 resection of pancreatic cancer: a multicenter randomized phase III trial.   J Clin Oncol. 2017;35(29):3330-3337. doi:10.1200/JCO.2017.72.6463 PubMedGoogle ScholarCrossref
39.
Ueno  H , Kosuge  T , Matsuyama  Y ,  et al.  A randomised phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese study group of adjuvant therapy for pancreatic cancer.   Br J Cancer. 2009;101(6):908-915. doi:10.1038/sj.bjc.6605256 PubMedGoogle ScholarCrossref
40.
Uesaka  K , Boku  N , Fukutomi  A ,  et al; JASPAC 01 Study Group.  Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01).   Lancet. 2016;388(10041):248-257. doi:10.1016/S0140-6736(16)30583-9 PubMedGoogle ScholarCrossref
41.
Van Laethem  JL , Hammel  P , Mornex  F ,  et al.  Adjuvant gemcitabine alone versus gemcitabine-based chemoradiotherapy after curative resection for pancreatic cancer: a randomized EORTC-40013-22012/FFCD-9203/GERCOR phase II study.   J Clin Oncol. 2010;28(29):4450-4456. doi:10.1200/JCO.2010.30.3446 PubMedGoogle ScholarCrossref
42.
Yoshitomi  H , Togawa  A , Kimura  F ,  et al; Pancreatic Cancer Chemotherapy Program of the Chiba University Department of General Surgery Affiliated Hospital Group.  A randomized phase II trial of adjuvant chemotherapy with uracil/tegafur and gemcitabine versus gemcitabine alone in patients with resected pancreatic cancer.   Cancer. 2008;113(9):2448-2456. doi:10.1002/cncr.23863 PubMedGoogle ScholarCrossref
43.
Brasiūniene  B , Juozaityte  E .  The effect of combined treatment methods on survival and toxicity in patients with pancreatic cancer.   Medicina (Kaunas). 2007;43(9):716-725. doi:10.3390/medicina43090093 PubMedGoogle ScholarCrossref
44.
Imamura  M , Doi  R .  Treatment of locally advanced pancreatic cancer: should we resect when resectable?   Pancreas. 2004;28(3):293-295. doi:10.1097/00006676-200404000-00015 PubMedGoogle ScholarCrossref
45.
Jin  C , Yao  L , Long  J ,  et al.  Effect of multiple-phase regional intra-arterial infusion chemotherapy on patients with resectable pancreatic head adenocarcinoma.   Chin Med J (Engl). 2009;122(3):284-290.PubMedGoogle Scholar
46.
Kosuge  T , Kiuchi  T , Mukai  K , Kakizoe  T ; Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer (JSAP).  A multicenter randomized controlled trial to evaluate the effect of adjuvant cisplatin and 5-fluorouracil therapy after curative resection in cases of pancreatic cancer.   Jpn J Clin Oncol. 2006;36(3):159-165. doi:10.1093/jjco/hyi234 PubMedGoogle ScholarCrossref
47.
Neoptolemos  JP , Dunn  JA , Stocken  DD ,  et al; European Study Group for Pancreatic Cancer.  Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial.   Lancet. 2001;358(9293):1576-1585. doi:10.1016/S0140-6736(01)06651-X PubMedGoogle ScholarCrossref
48.
Neoptolemos  JP , Stocken  DD , Dunn  JA ,  et al; European Study Group for Pancreatic Cancer.  Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial.   Ann Surg. 2001;234(6):758-768. doi:10.1097/00000658-200112000-00007 PubMedGoogle ScholarCrossref
49.
Neoptolemos  JP , Stocken  DD , Friess  H ,  et al; European Study Group for Pancreatic Cancer.  A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer.   N Engl J Med. 2004;350(12):1200-1210. doi:10.1056/NEJMoa032295 PubMedGoogle ScholarCrossref
50.
Palmer  DH , Stocken  DD , Hewitt  H ,  et al.  A randomized phase 2 trial of neoadjuvant chemotherapy in resectable pancreatic cancer: gemcitabine alone versus gemcitabine combined with cisplatin.   Ann Surg Oncol. 2007;14(7):2088-2096. doi:10.1245/s10434-007-9384-x PubMedGoogle ScholarCrossref
51.
Yeo  TP , Burrell  SA , Sauter  PK ,  et al.  A progressive postresection walking program significantly improves fatigue and health-related quality of life in pancreas and periampullary cancer patients.   J Am Coll Surg. 2012;214(4):463-475. doi:10.1016/j.jamcollsurg.2011.12.017 PubMedGoogle ScholarCrossref
52.
Abrams  RA , Winter  KA , Safran  H ,  et al.  Results of the NRG Oncology/RTOG 0848 adjuvant chemotherapy question-erlotinib+gemcitabine for resected cancer of the pancreatic head: a phase II randomized clinical trial.   Am J Clin Oncol. 2020;43(3):173-179. doi:10.1097/COC.0000000000000633 PubMedGoogle ScholarCrossref
53.
Jones  RP , Psarelli  EE , Jackson  R ,  et al; European Study Group for Pancreatic Cancer.  Patterns of recurrence after resection of pancreatic ductal adenocarcinoma: a secondary analysis of the ESPAC-4 randomized adjuvant chemotherapy trial.   JAMA Surg. 2019;154(11):1038-1048. doi:10.1001/jamasurg.2019.3337 PubMedGoogle ScholarCrossref
54.
Versteijne  E , Suker  M , Groothuis  K ,  et al; Dutch Pancreatic Cancer Group.  Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: results of the Dutch randomized phase III PREOPANC trial.   J Clin Oncol. 2020;38(16):1763-1773. doi:10.1200/JCO.19.02274 PubMedGoogle ScholarCrossref
55.
Bilici  A .  Prognostic factors related with survival in patients with pancreatic adenocarcinoma.   World J Gastroenterol. 2014;20(31):10802-10812. doi:10.3748/wjg.v20.i31.10802 PubMedGoogle ScholarCrossref
56.
Maeda  S , Ariake  K , Iseki  M ,  et al.  Prognostic indicators in pancreatic cancer patients undergoing total pancreatectomy.   Surg Today. 2020;50(5):490-498. doi:10.1007/s00595-019-01924-4 PubMedGoogle ScholarCrossref
57.
Lin  R , Han  CQ , Wang  WJ ,  et al.  Analysis on survival and prognostic factors in patients with resectable pancreatic adenocarcinoma.   J Huazhong Univ Sci Technolog Med Sci. 2017;37(4):612-620. doi:10.1007/s11596-017-1780-2 PubMedGoogle ScholarCrossref
58.
Bailey  P , Chang  DK , Nones  K ,  et al; Australian Pancreatic Cancer Genome Initiative.  Genomic analyses identify molecular subtypes of pancreatic cancer.   Nature. 2016;531(7592):47-52. doi:10.1038/nature16965 PubMedGoogle ScholarCrossref
59.
Collisson  EA , Bailey  P , Chang  DK , Biankin  AV .  Molecular subtypes of pancreatic cancer.   Nat Rev Gastroenterol Hepatol. 2019;16(4):207-220. doi:10.1038/s41575-019-0109-y PubMedGoogle ScholarCrossref
60.
Strijker  M , van der Sijde  F , Suker  M ,  et al; Dutch Pancreatic Cancer Group.  Preoperative serum ADAM12 levels as a stromal marker for overall survival and benefit of adjuvant therapy in patients with resected pancreatic and periampullary cancer.   HPB (Oxford). 2021;23(12):1886-1896. doi:10.1016/j.hpb.2021.05.001PubMedGoogle ScholarCrossref
61.
Dijk  F , Veenstra  VL , Soer  EC ,  et al.  Unsupervised class discovery in pancreatic ductal adenocarcinoma reveals cell-intrinsic mesenchymal features and high concordance between existing classification systems.   Sci Rep. 2020;10(1):337. doi:10.1038/s41598-019-56826-9 PubMedGoogle ScholarCrossref
62.
Cancer Genome Atlas Research Network.  Integrated genomic characterization of pancreatic ductal adenocarcinoma.   Cancer Cell. 2017;32(2):185-203.e113. doi:10.1016/j.ccell.2017.07.007 PubMedGoogle ScholarCrossref
63.
Martinez-Useros  J , Garcia-Foncillas  J .  The role of BRCA2 mutation status as diagnostic, predictive, and prognosis biomarker for pancreatic cancer.   Biomed Res Int. 2016;2016:1869304. doi:10.1155/2016/1869304 PubMedGoogle ScholarCrossref
64.
Holter  S , Borgida  A , Dodd  A ,  et al.  Germline BRCA mutations in a large clinic-based cohort of patients with pancreatic adenocarcinoma.   J Clin Oncol. 2015;33(28):3124-3129. doi:10.1200/JCO.2014.59.7401 PubMedGoogle ScholarCrossref
65.
Iqbal  J , Ragone  A , Lubinski  J ,  et al; Hereditary Breast Cancer Study Group.  The incidence of pancreatic cancer in BRCA1 and BRCA2 mutation carriers.   Br J Cancer. 2012;107(12):2005-2009. doi:10.1038/bjc.2012.483 PubMedGoogle ScholarCrossref
66.
Creemers  A , Krausz  S , Strijker  M ,  et al.  Clinical value of ctDNA in upper-GI cancers: a systematic review and meta-analysis.   Biochim Biophys Acta Rev Cancer. 2017;1868(2):394-403. doi:10.1016/j.bbcan.2017.08.002 PubMedGoogle ScholarCrossref
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close