Impact of Margin Status on Survival in Patients with Pancreatic Ductal Adenocarcinoma Receiving Neoadjuvant Chemotherapy

2020 ◽  
Author(s):  
Ryan K. Schmocker ◽  
Daniel Delitto ◽  
Michael J. Wright ◽  
Ding Ding ◽  
John L. Cameron ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Margin Status ◽  
Ductal Adenocarcinoma

scholarly journals Adjuvant Chemotherapy Associated with Survival Benefit Following Neoadjuvant Chemotherapy and Pancreatectomy for Pancreatic Ductal Adenocarcinoma: A Population-Based Cohort Study

2021 ◽  
Author(s):  
Sivesh K. Kamarajah ◽  
Steven A. White ◽  
Samer A. Naffouje ◽  
George I Salti ◽  
Fadi Dahdaleh
Keyword(s):  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Cox Regression ◽  
Margin Status ◽  
Ductal Adenocarcinoma ◽  
Term Survival ◽  
Cox Regression Analysis ◽  
Cancer Data ◽  
The Impact

Abstract Background Data supporting the routine use of adjuvant chemotherapy (AC) compared with no AC (noAC) following neoadjuvant chemotherapy (NAC) and resection for pancreatic ductal adenocarcinoma (PDAC) are lacking. This study aimed to determine whether AC improves long-term survival in patients receiving NAC and resection. Methods Patients receiving resection for PDAC following NAC from 2004 to 2016 were identified from the National Cancer Data Base (NCDB). Patients with a survival rate of < 6 months were excluded to account for immortal time bias. Propensity score matching (PSM) and Cox regression analysis were performed to account for selection bias and analyze the impact of AC on overall survival. Results Of 4449 (68%) noAC patients and 2111 (32%) AC patients, 2016 noAC patients and 2016 AC patients remained after PSM. After matching, AC was associated with improved survival (median 29.4 vs. 24.9 months; p < 0.001), which remained after multivariable adjustment (HR 0.81, 95% confidence interval [CI] 0.75–0.88; p < 0.001). On multivariable interaction analyses, this benefit persisted irrespective of nodal status: N0 (hazard ratio [HR] 0.80, 95% CI 0.72–0.90; p < 0.001), N1 (HR 0.76, 95% CI 0.67–0.86; p < 0.001), R0 margin status (HR 0.82, 95% CI 0.75–0.89; p < 0.001), R1 margin status (HR 0.77, 95% CI 0.64–0.93; p = 0.007), no neoadjuvant radiotherapy (NART; HR 0.84, 95% CI 0.74–0.96; p = 0.009), and use of NART (HR 0.80, 95% CI 0.73–0.88; p < 0.001). Stratified analysis by nodal, margin, and NART status demonstrated consistent results. Conclusion AC following NAC and resection is associated with improved survival, even in margin-negative and node-negative disease. These findings suggest completing planned systemic treatment should be considered in all resected PDACs previously treated with NAC.

scholarly journals Is neoadjuvant chemotherapy always justified in clinical T1 pancreatic ductal adenocarcinoma?

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S233
Author(s):  
H.S. Kim ◽  
K. Nakagawa ◽  
T. Akahori ◽  
K. Nakamura ◽  
T. Takagi ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Ductal Adenocarcinoma

scholarly journals Clinical impacts of resection margin status and clinicopathologic parameters on pancreatic ductal adenocarcinoma

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Tsengelmaa Jamiyan ◽  
Takayuki Shiraki ◽  
Yoshihiro Kurata ◽  
Masanori Ichinose ◽  
Keiichi Kubota ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Resection Margin ◽  
Margin Status ◽  
Ductal Adenocarcinoma ◽  
Resection Margin Status ◽  
Clinicopathologic Parameters

Myosteatosis to predict postoperative morbidity in pancreatic ductal adenocarcinoma patients receiving neoadjuvant chemotherapy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16754-e16754
Author(s):  
Raphael Louie ◽  
Gabriel Aleixo ◽  
Allison Mary Deal ◽  
Emily Damone ◽  
Jaclyn Tremont-Portelli ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Postoperative Morbidity ◽  
Tube Feeding ◽  
Ct Scans ◽  
Ductal Adenocarcinoma ◽  
Baseline Body Mass Index ◽  
Cross Sectional ◽  
Student’S T ◽  
Morbidity Risk

e16754 Background: Myosteatosis (adipose deposits in muscle) can be detected on cross-sectional imaging through variations in Skeletal Muscle Density (SMD). Patients with myosteatosis tend to have lower overall survival, increased chemotherapy toxicity, and shorter progression-free intervals across cancer types. We investigated whether changes in myosteatosis during neoadjuvant chemotherapy can predict postoperative morbidity risk in patients with pancreatic ductal adenocarcinoma (PDAC). Methods: This is a retrospective cohort study from 2014-2019 of patients with biopsy-proven PDAC who completed neoadjuvant chemotherapy and R0/1 resection (R1: margin < 1mm or microscopically positive). We obtained preoperative patient (age at diagnosis, baseline body mass index (BMI), sex, race, comorbidities) and treatment data (neoadjuvant chemotherapy regimen and duration, time from completion of systemic therapy to surgery, type of operation). Primary outcomes were postoperative complications and 90-day readmission. Average SMD was measured using imaging analysis software at the L3 level on axial abdominal CT scans at the time of diagnosis and at completion of neoadjuvant therapy (SliceOmatic TomoVision QC, Can). We defined SMDΔ as the decrease in SMD during neoadjuvant chemotherapy. Descriptive statistics and Student’s t-test were performed with STATA. Results: We identified 44 patients who received neoadjuvant chemotherapy, achieved a R0/1 resection, and had available CT scans for body composition evaluation. The postoperative complication rate was 43% (n = 19) and 90-day readmission rate was 30% (n = 13). Lower SMD at diagnosis was associated with increased postoperative delirium (p < 0.01) and 90-day readmission (p = 0.02). Greater SMDΔ was associated with increased ICU utilization (p < 0.01) and tube feeding upon discharge (p = 0.03). There was no significant association between preoperative BMI or albumin and our primary outcomes. Conclusions: Preoperative SMD and SMDΔ, rather than albumin or BMI, can predict postoperative morbidity in PDAC patients who received neoadjuvant chemotherapy. This study provides the framework for future studies to develop and validate a tool to predict postoperative morbidity risk in these patients.

Assessment of prognostic factors in pancreatic ductal adenocarcinoma: Focus on the retroperitoneal margin

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15670-e15670
Author(s):  
A. M. Bellizzi ◽  
M. Bloomston ◽  
S. M. Bellizzi ◽  
W. L. Marsh ◽  
W. L. Frankel
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Perineural Invasion ◽  
Surgical Margin ◽  
Margin Status ◽  
Ductal Adenocarcinoma ◽  
Rank Analysis ◽  
Kaplan Meier ◽  
Incidence And Mortality ◽  
Pancreatic Neck ◽  
Highly Correlated

e15670 Background: Pancreatic ductal adenocarcinoma (PDA) is a leading cause of cancer death in the West, with a nearly superimposable incidence and mortality. Resection is the only chance for cure, and various features in resection specimens correlate with outcome. While most consider the uncinate margin (UM) to be the true retroperitoneal margin, it has been suggested that the posterior pancreatic surface (PPS) may also be important. At another site with a retroperitoneal margin (i.e. rectum), 1 mm margins are significant. We thus evaluated margin status in various ways, focusing on the retroperitoneal region and emphasizing outcome. Methods: We identified all pancreaticoduodenectomies for PDA over a 6 year period in which the PPS was histologically evaluable. Tumors were assessed for the following: size, stage, grade, lymph node (LN) status, vascular and perineural invasion, and margin status. Margin status was evaluated in 3 ways: traditional margins (tumor at pancreatic neck, bile duct, and/or uncinate margins), 1 mm margins (traditional + tumor within 1 mm of UM), and PPS margins (traditional + tumor within 1 mm of PPS or UM). Kaplan-Meier survival curves were constructed with univariate factors compared by log rank analysis; multivariate analysis was done using the Cox proportional hazard model. Results: Fifty-one tumors exhibited the following features: size (mean 3.3 cm), stage (48 T3), grade (27 low, 24 high), LN status (11 neg, 40 pos), positive margins (13 traditional, 23 1 mm, and 32 PPS). Nearly all tumors exhibited at least focal vascular and perineural invasion. Grade influenced survival (p=0.0001), while size (p=0.417) and traditional and PPS margins did not (p=0.5 and 0.95). LN status and 1 mm margins trended toward significance (p=0.17 and 0.2). Conclusions: Use of a two-tiered grading system is highly correlated with survival. Neither tumor size, LN status, nor traditional or PPS margins are significant, while 1 mm margins trend toward significance. Although lack of significance of some features (i.e. size, LN status, and traditional margin status) may be attributable to modest sample size, lack of significance of the PPS may reflect its anatomic nature (i.e. not a true surgical margin). Additional study of 1 mm margins in a larger tumor set is warranted. No significant financial relationships to disclose.

scholarly journals Effect and limitation of neoadjuvant chemotherapy for pancreatic ductal adenocarcinoma: consideration from a new perspective

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yoshihiro Kurata ◽  
Takayuki Shiraki ◽  
Masanori Ichinose ◽  
Keiichi Kubota ◽  
Yasuo Imai
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Locally Advanced ◽  
Nodal Metastasis ◽  
Ductal Adenocarcinoma ◽  
Resected Specimen ◽  
Small Subset ◽  
Borderline Resectable ◽  
Postoperative Prognosis ◽  
Pathologic Stage

Abstract Background Effect of neoadjuvant chemotherapy (NAC) for pancreatic ductal adenocarcinoma (PDAC) has remained under investigation. We investigated its effect from a unique perspective and discussed its application. Patients and methods We retrospecively analyzed consecutive 131 PDAC patients who underwent pancreatoduodenectomy and distal pancreatectomy. Clinicopathologic data at surgery and postoperative prognosis were compared between patients who underwent upfront surgery (UFS) (n = 64) and those who received NAC (n = 67), of which 62 (92.5%) received gemcitabine plus S-1 (GS). The GS regimen resulted in about 15% of partial response and 85% of stable disease in a previous study which analyzed a subset of this study subjects. Results Tumor size was marginally smaller, degree of nodal metastasis and rate of distant metastasis were significantly lower, and pathologic stage was significantly lower in the NAC group than in the UFS group. In contrast, significant differences were not observed in histopathologic features such as vessel and perineural invasions and differentiation grade. Notably, disease-free and overall survivals were similar between the two groups adjusted for the pathologic stage, suggesting that effects of NAC, including macroscopically undetectable ones such as control of micro-metastasis and devitalizing tumor cells, may not be remarkable in the majority of PDAC, at least with respect to the GS regimen. Conclusions NAC may be useful in downstaging and improving prognosis in a small subset of tumors. However, postoperative prognosis may be determined at the pathologic stage of resected specimen with or without NAC. Therefore, NAC may be applicable to borderline resectable and locally advanced PDAC for enabling surgical resection, but UFS would be desirable for primary resectable PDAC.

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