Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

Is a Pathological Complete Response Following Neoadjuvant Chemoradiation Associated With Prolonged Survival in Patients With Pancreatic Cancer?

He, Jin, MD, PhD*; Blair, Alex, B., MD*; Groot, Vincent, P., MD*; Javed, Ammar, A., MD*; Burkhart, Richard, A., MD*; Gemenetzis, Georgios, MD*; Hruban, Ralph, H., MD; Waters, Kevin, M., MD, PhD; Poling, Justin, MD; Zheng, Lei, MD, PhD; Laheru, Daniel, MD; Herman, Joseph, M., MD, MSc§; Makary, Martin, A., MD, MPH*; Weiss, Matthew, J., MD*; Cameron, John, L., MD*; Wolfgang, Christopher, L., MD, PhD*

doi: 10.1097/SLA.0000000000002672
FEATURES

Objectives: To describe the survival outcome of patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma (BR/LA-PDAC) who have a pathologic complete response (pCR) following neoadjuvant chemoradiation.

Background: Patients with BR/LA-PDAC are often treated with neoadjuvant chemoradiation in an attempt to downstage the tumor. Uncommonly, a pCR may result.

Methods: A retrospective review of a prospectively maintained database was performed at a single institution. pCR was defined as no viable tumor identified in the pancreas or lymph nodes by pathology. A near complete response (nCR) was defined as a primary tumor less than 1 cm, without nodal metastasis. Overall survival (OS) and disease-free survival (DFS) were reported.

Results: One hundred eighty-six patients with BR/LA-PDAC underwent neoadjuvant chemoradiation and subsequent pancreatectomy. Nineteen patients (10%) had a pCR, 29 (16%) had an nCR, and the remaining 138 (74%) had a limited response. Median DFS was 26 months in patients with pCR, which was superior to nCR (12 months, P = 0.019) and limited response (12 months, P < 0.001). The median OS of nCR (27 months, P = 0.003) or limited response (26 months, P = 0.001) was less than that of pCR (more than 60 months). In multivariable analyses pCR was an independent prognostic factor for DFS (HR = 0.45; 0.22–0.93, P = 0.030) and OS (HR=0.41; 0.17–0.97, P = 0.044). Neoadjuvant FOLFIRINOX (HR=0.47; 0.26–0.87, P = 0.015) and negative lymph node status (HR=0.57; 0.36–0.90, P = 0.018) were also associated with improved survival.

Conclusions: Patients with BR/LA-PDAC who had a pCR after neoadjuvant chemoradiation had a significantly prolonged survival compared with those who had nCR or a limited response.

*Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD

Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD

Department of Medical Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD

§Department of Radiation Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD.

Reprints: Christopher L. Wolfgang MD, PhD, Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287. E-mail: cwolfga2@jhmi.edu.

JH and ABB equally contributed to this manuscript

The authors report no conflicts of interest.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.