Adjuvant therapy following neoadjuvant chemotherapy and surgery for oesophageal adenocarcinoma in patients with clear resection margins

315 Background: Positive surgical margins are reported in 1-5% of specimens following radical cystectomy (RC) for urothelial carcinoma of the bladder (UC). Negative margin (R0) resection correlates with improved overall survival (OS) following RC in individual institutional analyses compared to microscopic (R1) or grossly (R2) positive margins. The present study hypothesized that RC surgical resection margins vary between treating centers. Methods: Patients with UC undergoing RC were identified from the National Cancer Database (2004-2013). Treating centers were categorized as Academic Cancer Centers (ACC) and Community Cancer Centers (CCC). Rates of R0 vs. R1/2 resection were examined and logistic regression was performed to determine predictive factors for margin status. Results: A total of 40,187 patients were identified with a median age of presentation of 68 years. RC was performed equally at ACC (52%) compared to CCC (48%). Neoadjuvant chemotherapy was utilized more often at ACC (21%) compared to CCC (14%). RC at ACC was associated with higher rates of R0 resections (90%) compared to CCC (88%) (p < 0.001). On logistic regression, after adjusting for age, sex, ethnicity, comorbidities, disease stage, tumor grade, tumor size, and use of neoadjuvant chemotherapy, RC at ACC were associated with decreased risk of experiencing positive margins (OR = 0.79, 95% CI 0.74-0.85). Following multivariate regression, RC performed at ACC were associated with a significant hazard ratio (HR) for survival (HR = 0.88, 95% CI 0.85-0.91). Compared to all variables, R1/2 resection status was the next most significant predictor for poor survival in RC patients (HR = 1.83, 95% CI 1.75-1.91) after cancer stage. Conclusions: Surgical margin is an important, independent risk factor for mortality in patients undergoing RC for UC. RC at ACCs is associated with a higher rate of negative resection margins, suggesting that site of care may impact bladder cancer patient’s oncologic outcomes.

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Comparison of neoadjuvant and adjuvant therapy for resectable pancreatic cancer using Markov decision modeling.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.448 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 448-448

Author(s):

Minsig Choi ◽

Sayaka Ishizawa ◽

Yan Liang ◽

Sina Rashidian ◽

Aaron R. Sasson ◽

...

Keyword(s):

Pancreatic Cancer ◽

Clinical Trials ◽

Neoadjuvant Chemotherapy ◽

Life Expectancy ◽

Adjuvant Therapy ◽

Clinical Outcome ◽

Resectable Pancreatic Cancer ◽

Cancer Data ◽

Study Results ◽

Quality Adjusted Life

448 Background: Meta-analysis of smaller studies have shown that neoadjuvant chemotherapy is more beneficial for patients with resectable pancreatic cancer than upfront surgery by comparing life expectancy (LE) and quality-adjusted life expectancy (QALE) computed from Markov models. The study results utilized literature data using several small clinical trials but no individual patient data was used and only gemzar based therapy was studied. Methods: Markov model was used to calculate the LE and QALE for adjuvant and neoadjuvant chemotherapy and individual patient parameters was used in the model to refine certain clinical outcome datapoints. We used 278 patients pancreatic cancer data from 2008 to 2017 from Stony Brook University and used the literature data from randomized clinical trials studying gemzar (GEM), gemzar and capecitabine (GEM+CAP) and modified FOLFIRINOX (mFOL). The median OS for each model was obtained by computer simulation. Results: Intensive adjuvant chemotherapy using mFOL had best simulation outcome with median OS (52.5 months), LE (81.5 months), and QALE (65.0 quality-adjusted life months) compared to using GEM (40.5, 66.5, and 52.9 months for median OS, LE, and QALE), GEM+CAP (16.5, 28.0, and 21.9 months for median OS, LE, and QALE), and 5-FU (16.5, 26.9, and 21.1 months for median OS, LE, and QALE). The neoadjuvant chemotherapy approach improved LE and QALE but not in median OS when compared to adjuvant therapy. Conclusions: Mathematical modeling confirms the improved clinical outcome for modified FOLFIRINOX in resectable pancreatic cancer. The benefit of neoadjuvant chemotherapy approach suggest further clinical trials are needed to determine the better treatment strategy for pancreatic cancer patients.

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