Survival outcome and prognostic factors of neoadjuvant treatment followed by resection for borderline resectable pancreatic cancer

Abstract

Purpose: Neoadjuvant treatment may provide improved survival outcomes for patients with borderline resectable pancreatic cancer (BRPC). The purpose of this study is to evaluate the clinical outcomes of neoadjuvant treatment and to identify prognostic factors.

Methods: Forty patients who met the National Comprehensive Cancer Network definition of BRPC and received neoadjuvant treatment followed by surgery between 2007 and 2015 were evaluated. Prospectively collected clinicopathological outcomes were analyzed retrospectively.

Results: The mean age was 61.7 years and the male-to-female ratio was 1.8:1. Twenty-six, 3, and 11 patients received gemcitabine-based chemotherapy, 5-fluorouracil, and FOLFIRINOX, respectively. The 2-year survival rate (2YSR) was 36.6% and the median overall survival (OS) was 20 months. Of the 40 patients, 34 patients underwent resection and the 2YSR was 41.2% while the 2YSR of patients who did not undergo resection was 16.7% (P = 0.011). The 2YSR was significantly higher in patients who had partial response compared to stable disease (60.6% vs. 24.3%, P = 0.038), in patients who did than did not show a CA 19-9 response after neoadjuvant treatment (40.5% vs. 0%, P = 0.039) and in patients who did than did not receive radiotherapy (50.8% vs. 25.3%, P = 0.036). Five patients had local recurrence and 17 patients had systemic recurrence with a median disease specific survival of 15 months.

Conclusion: Neoadjuvant treatment followed by resection is effective for BRPC. Pancreatectomy and neoadjuvant treatment response may affect survival. Effective systemic therapy is needed to improve long-term survival since systemic metastasis accounts for a high proportion of recurrence.

Keywords: Neoadjuvant therapy; Pancreatic neoplasms; Prognosis; Surgery.

Fig. 1. Overall survival curve after neoadjuvant treatment followed by operation. 2YSR, 2-year survival rate.

Fig. 2. Survival curves according to the factors. (A) Survival curves according to the chemotherapy regimen, radiotherapy; (B) survival curves according to the neoadjuvant treatment response, RECIST criteria or CA 19-9 change; (C) survival curves according to the pancreatectomy. 2YSR, 2-year survival rate; 5-FU, 5-fluorouracil; RT, radiotherapy; RECIST, Response Evaluation Criteria In Solid Tumors; PR, partial response; SD, stable disease.

Fig. 3. Pancreatectomy subgroup survival curves according to the factors. (A) Survival curves according to the chemotherapy regimen, radiotherapy; (B) survival curve according to the resection status, lymph node metastasis. 2YSR, 2-year survival rate; 5-FU, 5-fluorouracil; RT, radiotherapy.

Fig. 4. Disease-free survival curve after neoadjuvant treatment followed by operation.