Retrospective analysis of efficacy and safety of cell-free and concentrated ascites reinfusion therapy in pancreatic cancer patients with malignant ascites

Background: Cell-free and Concentrated Ascites Reinfusion Therapy (CART) is expected to improve some symptoms related to ascites. However, its efficacy and safety for malignant ascites of pancreatic cancer (PC) patients has not been fully elucidated. The aim of this study is to assess the clinical significance of CART in PC with malignant ascites. Methods: In this retrospective analysis, we examined 226 CART processes performed on 54 patients with advanced PC from April 2010 to March 2018 in our institution. Adverse events (AE) related to CART and patient’s symptoms were assessed by using CTCAE v4.0. Improvements in ECOG Performance Status (PS) and patient’s symptoms were analyzed using Wilcoxon signed rank test. Survival analyses were performed with Kaplan-Meier method, Log-rank test, and Cox-proportional hazard model. Results: Patients characteristics were as follows: male/female 32/22, median age 70 (range 41-80), median number of CART 2 (range 1-42), PS (1/2/3/4) 10/22/18/4, primary surgery (Yes/No) 3/51, chemotherapy before CART (Yes/No) 35/19, and chemotherapy after CART (Yes/No) 16/38, respectively. Following initial CART, PS (p = 0.003), anorexia (p < 0.001), and fatigue (p < 0.001) were significantly improved. Three patients with PS3 and two patients with grade3 anorexia could receive chemotherapy along with improvement of their symptom after CART. The median overall survival (OS) was 33.0 days (95% CI; 21.9-44.0). In Cox multivariate analysis, PS had an independent prognostic impact (hazard ratio: 0.354, 95%CI: 0.163-0.771, p = 0.009). Especially for PS0-2 patients after CART (N = 37), receiving chemotherapy was significantly related to better OS (hazard ratio: 0.393, 95%CI: 0.177-0.874, p = 0.022). There were no severe AE related to CART and treatment-related death. Conclusions: CART was performed safely and was useful to improve some symptoms for PC patients with malignant ascites. Our results suggested CART could be lead to administrate the chemotherapy and may contribute to the improvement of survival in patients with PC. Legal entity responsible for the study: Kushiro Rosai Hospital. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.