Evaluation of Pathologic Response on Overall Survival After Neoadjuvant Therapy in Pancreatic Ductal Adenocarcinoma. Issue 7 (August 2020)

• Record Type: Journal Article
• Authors: Sell, Naomi M.; Lee, Grace C.; Fernández-Del Castillo, Carlos; Ferrone, Cristina R.; Warshaw, Andrew L.; Hong, Theodore S.; Blaszkowsky, Lawrence S.; Lillemoe, Keith D.; Qadan, Motaz
• Is Part Of: Pancreas. Volume 49:Issue 7(2020)
• Publication Date: 2020-08
• Subjects: pathologic complete response -- near-complete response -- overall survival -- neoadjuvant therapy -- pancreatic ductal adenocarcinoma; Pancreas -- Diseases -- Periodicals; Pancreas -- Periodicals; Neuroendocrine tumors -- Periodicals; 616.37005
• DOI: 10.1097/MPA.0000000000001590
• Languages: English
• ISSNs: 0885-3177

Abstract

Abstract : Objectives: Single-institution studies have shown improved outcomes among patients with a pathologic complete response (pCR) following neoadjuvant therapy. We sought to evaluate the impact of pCR and near-complete response (nCR) on overall survival (OS) using a large national database. Methods: The National Cancer Database was queried for patients given a diagnosis of pancreatic cancer from 2004 to 2014. A pCR was defined as no tumor identified in the pancreas after surgical resection. An nCR was defined as a primary tumor less than 1 cm without lymph node metastases. The primary outcome was OS. Results: A total of 5364 patients underwent neoadjuvant chemotherapy and/or radiation followed by pancreatectomy. Forty-one patients (0.8%) had a pCR, 54 (1%) had an nCR, and the remaining 5266 (98.2%) had an otherwise incomplete response. Patients with pCR had a median OS of 43 months compared with 24 months for nCR and 23 months for incomplete response ( P < 0.0001). Only pCR was associated with improved OS on adjusted Cox regression. Conclusions: For patients given a diagnosis of pancreatic cancer who underwent neoadjuvant treatment and surgical resection, achieving a pCR was associated with improved OS compared with those with residual tumor. An association between nCR and improved survival was not observed.