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. 2021 Sep;124(3):308-316.
doi: 10.1002/jso.26510. Epub 2021 Apr 24.

Predictors of early recurrence following neoadjuvant chemotherapy and surgical resection for localized pancreatic adenocarcinoma

Sowmya Narayanan  1 , Samer AlMasri  1 , Mazen Zenati  2 , Ibrahim Nassour  1 , Asmita Chopra  1 , Caroline Rieser  1 , Katelyn Smith  3 , Vivianne Oyefusi  4 , Tracy Daum  1 , Nathan Bahary  5 , David Bartlett  1 , Kenneth Lee  1 , Amer Zureikat  1 , Alessandro Paniccia  1
Affiliations

Predictors of early recurrence following neoadjuvant chemotherapy and surgical resection for localized pancreatic adenocarcinoma

Sowmya Narayanan et al. J Surg Oncol. 2021 Sep.

Abstract

Background and objectives: Neoadjuvant chemotherapy (NAT) for pancreatic adenocarcinoma (PDAC) is increasingly being utilized. However, a significant number of patients will experience early recurrence, possibly negating the benefit of surgery. We aimed to identify factors implicated in early disease recurrence.

Methods: A retrospective review of pancreaticoduodenectomies performed between 2005 and 2017 at our institution for PDAC following NAT was performed. A 6-month cut-off was used to stratify patients into early/late recurrence groups. Multivariate analysis was performed to identify predictors of recurrence.

Results: Of 273 patients, 64 (23%) developed early recurrence or died within 90 days of surgery. The median time to recurrence was 4 months (95% confidence interval [CI]: 2.2-4.3) in the early group versus 16 months (95% CI: 13.7-19.9) in the late group. The former had higher baseline and post-NAT Ca19-9 levels than the latter (472 vs. 153 IU/ml, p = 0.001 and 71 vs. 39 IU/ml, p = 0.005, respectively). A higher positive lymph node ratio significantly increased the risk of early recurrence (hazard ratio [HR]: 15.9, p < 0.001) while adjuvant chemotherapy was protective (HR: 0.4, p < 0.001).

Conclusion: Our findings acknowledge the limitations of clinically measured factors used to ascertain response to NAT and underline the need for individualized molecular markers that take into consideration the specific tumor biology.

Keywords: early recurrence; neoadjuvant chemotherapy; pancreatic cancer; pancreaticoduodenectomy.

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Figures

Figure 1.
Figure 1.
Patterns of early (≤6 months after resection) vs. late (>6 months after resection) recurrence in R and BR PDAC patients who received NAT followed by pancreaticoduodenectomy.
Figure 2.
Figure 2.
Overall (a) and progression-free (b) survival of R and BR PDAC patients after NAT and surgical resection.
See this image and copyright information in PMC

Comment in

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