Jordan M Cloyd1, Aslam Ejaz2, Chengli Shen2, Mary Dillhoff2, Terence M Williams3, Anne Noonan4, Timothy M Pawlik2, Allan Tsung2. 1. Department of Surgery The Ohio State University Wexner Medical Center, Columbus, Ohio, USA. Electronic address: jordan.cloyd@osumc.edu. 2. Department of Surgery The Ohio State University Wexner Medical Center, Columbus, Ohio, USA. 3. Department of Radiation Oncology The Ohio State University Wexner Medical Center, Columbus, Ohio, USA. 4. Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Abstract
BACKGROUND: Neoadjuvant therapy (NT) is increasingly utilized for patients with pancreatic ductal adenocarcinoma (PDAC) but the nationwide incidence and long-term prognosis of a pathologic complete response (pCR) remains poorly understood. METHODS: Patients with localized PDAC and known cT and pT stage who received NT prior to pancreatectomy from 2004 to 2016 were identified using the National Cancer Database. The clinicopathologic characteristics and long-term outcomes of patients who did and did not experience a pCR were compared. RESULTS: Among 7,902 patients who underwent NT prior to pancreatectomy, 244 (3.1%) experienced a pCR while 7,658 (96.9%) did not. On multivariable regression, longer duration of NT (OR 1.20, 95% CI 1.14-1.27 per month) and use of preoperative radiation (OR 9.98, 95% CI 3.05-32.71) were independently associated with a pCR. Median overall survival (OS) was longer among patients who experienced a pCR (77 vs 26 months, p < 0.001). On multivariate analysis, pCR was the strongest predictor of improved OS (HR 0.43, 95%CI 0.32-0.58, p < 0.001). CONCLUSION: A pCR following NT for PDAC occurs infrequently but is associated with significantly improved OS. Better predictors of response and more effective preoperative regimens should be aggressively sought.
BACKGROUND: Neoadjuvant therapy (NT) is increasingly utilized for patients with pancreatic ductal adenocarcinoma (PDAC) but the nationwide incidence and long-term prognosis of a pathologic complete response (pCR) remains poorly understood. METHODS: Patients with localized PDAC and known cT and pT stage who received NT prior to pancreatectomy from 2004 to 2016 were identified using the National Cancer Database. The clinicopathologic characteristics and long-term outcomes of patients who did and did not experience a pCR were compared. RESULTS: Among 7,902 patients who underwent NT prior to pancreatectomy, 244 (3.1%) experienced a pCR while 7,658 (96.9%) did not. On multivariable regression, longer duration of NT (OR 1.20, 95% CI 1.14-1.27 per month) and use of preoperative radiation (OR 9.98, 95% CI 3.05-32.71) were independently associated with a pCR. Median overall survival (OS) was longer among patients who experienced a pCR (77 vs 26 months, p < 0.001). On multivariate analysis, pCR was the strongest predictor of improved OS (HR 0.43, 95%CI 0.32-0.58, p < 0.001). CONCLUSION: A pCR following NT for PDAC occurs infrequently but is associated with significantly improved OS. Better predictors of response and more effective preoperative regimens should be aggressively sought.
Authors: Quisette P Janssen; Jacob L van Dam; Laura R Prakash; Deesje Doppenberg; Christopher H Crane; Casper H J van Eijck; Susannah G Ellsworth; William R Jarnagin; Eileen M O'Reilly; Alessandro Paniccia; Marsha Reyngold; Marc G Besselink; Matthew H G Katz; Ching-Wei D Tzeng; Amer H Zureikat; Bas Groot Koerkamp; Alice C Wei Journal: J Natl Compr Canc Netw Date: 2022-07 Impact factor: 12.693
Authors: Quisette P Janssen; Jacob L van Dam; Isabelle G Kivits; Marc G Besselink; Casper H J van Eijck; Marjolein Y V Homs; Joost J M E Nuyttens; Hongchao Qi; Hjalmar J van Santvoort; Alice C Wei; Roeland F de Wilde; Johanna W Wilmink; Geertjan van Tienhoven; Bas Groot Koerkamp Journal: Ann Surg Oncol Date: 2021-06-17 Impact factor: 5.344