ABSTRACT
Background: Despite improvements in surgical outcomes of pancreatic cancer (PC), postoperative hepatic metastasis remains a critical prognostic factor. This study investigated the efficacy of hepatic arterial infusion chemotherapy (HAIC) using high-dose 5-fluorouracil (5-FU) combined with systemic gemcitabine as adjuvant therapy.
Methods: Of 553 consecutive patients who underwent curative resection for PC between 2006 and 2022, we analyzed 470 patients after excluding those without adjuvant therapy (n=39), with URLA PC (n=12), and M1 disease (n=32). Of these, 301 patients received HAIC with systemic chemotherapy, while 169 received systemic chemotherapy alone. Weekly hepatic arterial infusion of 5-FU (1000mg/m2, 5-hour) was administered via an implantable port system concurrent with systemic gemcitabine (1000mg/m2), followed by additional systemic chemotherapy. Outcomes were compared between the HAIC and systemic chemotherapy (SC) groups.
Results: The HAIC group (completion rate: 82.7%) demonstrated significantly improved liver metastasis-free survival (median not reached vs. 139.2 months, p=0.003), overall survival (median 58.1 vs. 40.6 months), and disease-free survival (median 26.2 vs. 17.1 months, both p<0.001). Early hepatic metastasis within 6 months tended to be lower in the HAIC group (6.0% vs 11.0%, p=0.06), and overall early recurrence was significantly reduced (9.4% vs 21.3%, p<0.001). Multivariate analysis identified non-induction of HAIC (HR 1.48, p=0.006), age ≥75 years, preoperative tumor size ≥20mm, elevated preoperative CA19-9, lymph node metastasis, and borderline resectable status as independent poor prognostic factors for overall survival. Non-induction of HAIC and preoperative tumor size ≥20mm were independent risk factors for hepatic metastasis.
Conclusion: Adjuvant HAIC demonstrated significant suppression of hepatic metastasis and improved survival compared to conventional systemic chemotherapy. This strategy may represent a valuable treatment option for resected pancreatic cancer.