Faculty Collaboration Database

Post-therapy pathologic stage and survival in patients with pancreatic ductal adenocarcinoma treated with neoadjuvant chemoradiation. Cancer 2012 Jan 01;118(1):268-77

Date

07/08/2011

Pubmed ID

21735446

DOI

10.1002/cncr.26243

Scopus ID

2-s2.0-83855165798 (requires institutional sign-in at Scopus site)   72 Citations

Abstract

BACKGROUND: Neoadjuvant chemoradiation before surgery is an emerging treatment modality for pancreatic ductal adenocarcinoma (PDAC). However, analysis of prognostic factors is limited for patients with PDAC treated with neoadjuvant chemoradiation and pancreaticoduodenectomy (PD).

METHODS: The study population was comprised of 240 consecutive patients with PDAC who received neoadjuvant chemoradiation and PD and was compared with 60 patients who had no neoadjuvant therapy between 1999 and 2007. Clinicopathologic features were correlated with disease-free survival (DFS) and overall survival (OS).

RESULTS: Among the 240 treated patients, the 1-year and 3-year DFS rates were 52% and 32%, with a median DFS of 15.1 months. The 1-year and 3-year OS rates were 95% and 47%, with a median OS of 33.5 months. By univariate analysis, DFS was associated with age, post-therapy tumor stage (ypT), lymph node status (ypN), number of positive lymph nodes, and American Joint Committee on Cancer (AJCC) stage, whereas OS was associated with intraoperative blood loss, margin status, ypT, ypN, number of positive lymph nodes, and AJCC stage. By multivariate analysis, DFS was independently associated with age, number of positive lymph nodes, and AJCC stage, and OS was independently associated with differentiation, margin status, number of positive lymph nodes, and AJCC stage. In addition, the treated patients had better OS and lower frequency of lymph node metastasis than those who had no neoadjuvant therapy.

CONCLUSIONS: In patients with PDAC who received neoadjuvant chemoradiation and subsequent PD, post-therapy pathologic AJCC stage and number of positive lymph nodes are independent prognostic factors.

Author List

Estrella JS, Rashid A, Fleming JB, Katz MH, Lee JE, Wolf RA, Varadhachary GR, Pisters PW, Abdalla EK, Vauthey JN, Wang H, Gomez HF, Evans DB, Abbruzzese JL, Wang H

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Adult
Aged
Aged, 80 and over
Carcinoma, Pancreatic Ductal
Chemotherapy, Adjuvant
Combined Modality Therapy
Disease-Free Survival
Female
Humans
Lymphatic Metastasis
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Pancreatic Neoplasms
Prognosis
Radiotherapy, Adjuvant