PDA patients’ survival is intimately related to entire tumor resection (with no residual disease) feasibility, but this requires precise preoperative assessment to avoid unnecessary operations that do not afford survival benefits to patients. At present, the accuracy of determination of resectability is only 75%, meaning that one-fourth of patients endured an unnecessary laparotomy. This not only delays palliative systemic therapy3 but above all, even with incredible efforts in the last 15 years to refine patients’ selection and preoperative risk stratification, PDA surgery still reaches a 7 to 10% mortality rate following the surgery, in association with 30 to 60% of morbidity4. Finally, with a relapse rate of 80%, up to 30% of patients die of disease within 1 year after surgery5. In this “early-recurrence” subgroup, survival rates are comparable to those observed in patients with advanced disease ineligible to resection and thus undergoing antitumoral therapies alone6. Undoubtedly, a common feature of patients who will recur early is disease with more aggressive biological behaviour. So, it is primordial to select patients for surgery not only on the basis of surgical resectability, but also on the basis of the biological nature of the tumor to be included in the indications for surgery together with individual patients’ risk. For this purpose and in order to improve global patients’ survival and management, one needs non-invasive technics.
With respect to numerous biomarkers under development, pBioStrat-for-PDA wanted to provide a powerful tool for clinicians in order to better determine the resectability of a tumor by taking into account its biological nature. Indeed, our preliminary study revealed that high level of PAP/REG3A is observed for patients with PDA of higher grade, with reduced global and disease-free survival, even though those patients were eligible for surgery. At present, no biomarker intending to improve the prediction of resectability are under investigation. As a consequence the use of a non-invasive PAP/REG3A serum level determination will improve patients’ managements by (1) shortening the delay to start palliative chemotherapy, (2) limiting unnecessary surgery with important mortality/morbidity and (3) improving their redirection to adapted clinical trials, as the one targeting JAK2/STAT3 signalling.
While still of interest and representating a real need from the cinicians, this project was not achieved due to limitation in cohort implementation for several technical, societal and financial reasons. unfortunatly, only 250 samples were collected and the cohort is still under implementation.
Regarding those issues the socioeconomical impact could not be evaluated.
