Chad A Barnes1, Ashley N Krepline1, Mohammed Aldakkak1, Callisia N Clarke1, Kathleen K Christians1, Abdul H Khan2, Bryan C Hunt3, Paul S Ritch4, Ben George4, William A Hall5, Beth A Erickson5, Douglas B Evans1, Susan Tsai6. 1. Pancreatic Cancer Program, Department of Surgery, The Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA. 2. Pancreatic Cancer Program, Department of Gastroenterology, The Medical College of Wisconsin, Milwaukee, WI, USA. 3. Pancreatic Cancer Program, Department of Pathology, The Medical College of Wisconsin, Milwaukee, WI, USA. 4. Pancreatic Cancer Program, Department of Medical Oncology, The Medical College of Wisconsin, Milwaukee, WI, USA. 5. Pancreatic Cancer Program, Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, WI, USA. 6. Pancreatic Cancer Program, Department of Surgery, The Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA. stsai@mcw.edu.
Abstract
BACKGROUND: Among patients with localized pancreatic cancer (PC), the benefit of adjuvant therapy after neoadjuvant therapy and surgery is unknown. METHODS: Patients with localized PC who completed all intended neoadjuvant therapy and surgery were categorized based on the receipt of adjuvant therapy and by pathologic lymph node status (LN-/LN+). RESULTS: Data was available from 234 consecutive patients, 121 (52%) with resectable and 113 (48%) with borderline resectable PC. Of the 234 patients, 92 (39%) were LN+ and 142 (61%) were LN-. The median overall survival (OS) for the 234 patients was 39 months, 42.3 months for patients who received any adjuvant therapy and 34.1 months for those who did not (p = 0.29). Of the 92 LN+ patients, the median OS with and without adjuvant therapy was 29.5 and 23.2 months, respectively (p = 0.02). Of the142 LN- patients, the median OS was 45 months with or without adjuvant therapy (p = 0.86). In an adjusted hazard model, additional adjuvant therapy had a significant protective effect among LN+ patients (HR 0.39; 95% CI 0.21-0.70; p = 0.002) but not in LN- patients (HR 0.89; 95% CI 0.53-1.52; p = 0.68). CONCLUSION: Among patients with localized PC who received neoadjuvant therapy and surgery, the benefit of adjuvant therapy was limited to those with node-positive disease.
BACKGROUND: Among patients with localized pancreatic cancer (PC), the benefit of adjuvant therapy after neoadjuvant therapy and surgery is unknown. METHODS:Patients with localized PC who completed all intended neoadjuvant therapy and surgery were categorized based on the receipt of adjuvant therapy and by pathologic lymph node status (LN-/LN+). RESULTS: Data was available from 234 consecutive patients, 121 (52%) with resectable and 113 (48%) with borderline resectable PC. Of the 234 patients, 92 (39%) were LN+ and 142 (61%) were LN-. The median overall survival (OS) for the 234 patients was 39 months, 42.3 months for patients who received any adjuvant therapy and 34.1 months for those who did not (p = 0.29). Of the 92 LN+ patients, the median OS with and without adjuvant therapy was 29.5 and 23.2 months, respectively (p = 0.02). Of the142 LN- patients, the median OS was 45 months with or without adjuvant therapy (p = 0.86). In an adjusted hazard model, additional adjuvant therapy had a significant protective effect among LN+ patients (HR 0.39; 95% CI 0.21-0.70; p = 0.002) but not in LN- patients (HR 0.89; 95% CI 0.53-1.52; p = 0.68). CONCLUSION: Among patients with localized PC who received neoadjuvant therapy and surgery, the benefit of adjuvant therapy was limited to those with node-positive disease.
Entities:
Keywords:
Adjuvant therapy; Lymph node; Neoadjuvant therapy; Pancreatic cancer
Authors: Jordan M Winter; John L Cameron; Kurtis A Campbell; Meghan A Arnold; David C Chang; Joann Coleman; Mary B Hodgin; Patricia K Sauter; Ralph H Hruban; Taylor S Riall; Richard D Schulick; Michael A Choti; Keith D Lillemoe; Charles J Yeo Journal: J Gastrointest Surg Date: 2006-11 Impact factor: 3.452
Authors: Christina L Roland; Matthew H G Katz; Ching-Wei D Tzeng; Heather Lin; Gauri R Varadhachary; Rachna Shroff; Milind Javle; David Fogelman; Robert A Wolff; Jean N Vauthey; Christopher H Crane; Jeffrey E Lee; Jason B Fleming Journal: Ann Surg Oncol Date: 2015-09-08 Impact factor: 5.344
Authors: Jordan Kharofa; Susan Tsai; Tracy Kelly; Clint Wood; Ben George; Paul Ritch; Lauren Wiebe; Kathleen Christians; Douglas B Evans; Beth Erickson Journal: Radiother Oncol Date: 2014-10-15 Impact factor: 6.280
Authors: John P Neoptolemos; Daniel H Palmer; Paula Ghaneh; Eftychia E Psarelli; Juan W Valle; Christopher M Halloran; Olusola Faluyi; Derek A O'Reilly; David Cunningham; Jonathan Wadsley; Suzanne Darby; Tim Meyer; Roopinder Gillmore; Alan Anthoney; Pehr Lind; Bengt Glimelius; Stephen Falk; Jakob R Izbicki; Gary William Middleton; Sebastian Cummins; Paul J Ross; Harpreet Wasan; Alec McDonald; Tom Crosby; Yuk Ting Ma; Kinnari Patel; David Sherriff; Rubin Soomal; David Borg; Sharmila Sothi; Pascal Hammel; Thilo Hackert; Richard Jackson; Markus W Büchler Journal: Lancet Date: 2017-01-25 Impact factor: 79.321
Authors: Wenchuan Wu; Jin He; John L Cameron; Martin Makary; Kevin Soares; Nita Ahuja; Neda Rezaee; Joseph Herman; Lei Zheng; Daniel Laheru; Michael A Choti; Ralph H Hruban; Timothy M Pawlik; Christopher L Wolfgang; Matthew J Weiss Journal: Ann Surg Oncol Date: 2014-04-26 Impact factor: 5.344
Authors: Susan Tsai; Beth A Erickson; Kulwinder Dua; Paul S Ritch; Parag Tolat; Douglas B Evans Journal: J Oncol Pract Date: 2016-09 Impact factor: 3.840
Authors: Ryan P Merkow; Karl Y Bilimoria; James S Tomlinson; Jennifer L Paruch; Jason B Fleming; Mark S Talamonti; Clifford Y Ko; David J Bentrem Journal: Ann Surg Date: 2014-08 Impact factor: 12.969
Authors: Sung Jun Ma; Lucas M Serra; Austin J Bartl; Hye Ri Han; Fatemeh Fekrmandi; Austin J Iovoli; Gregory M Hermann; Han Yu; Anurag K Singh Journal: J Radiother Pract Date: 2021-04-14
Authors: Douglas S Swords; Samual R Francis; Shane Lloyd; Ignacio Garrido-Laguna; Sean J Mulvihill; Joshua D Gruhl; Miles C Christensen; Gregory J Stoddard; Matthew A Firpo; Courtney L Scaife Journal: J Gastrointest Surg Date: 2018-09-05 Impact factor: 3.452
Authors: David Wittmann; William A Hall; Kathleen K Christians; Chad A Barnes; Neil R Jariwalla; Mohammed Aldakkak; Callisia N Clarke; Ben George; Paul S Ritch; Matthew Riese; Abdul H Khan; Naveen Kulkarni; John Evans; Beth A Erickson; Douglas B Evans; Susan Tsai Journal: Front Oncol Date: 2020-04-15 Impact factor: 6.244
Authors: Sivesh K Kamarajah; Steven A White; Samer A Naffouje; George I Salti; Fadi Dahdaleh Journal: Ann Surg Oncol Date: 2021-03-30 Impact factor: 5.344