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. 2023 Sep;75(6):1497-1508.
doi: 10.1007/s13304-023-01628-y. Epub 2023 Aug 14.

Pathologic tumor response to neoadjuvant therapy in resected pancreatic cancer: does it affect prognosis?

G Donisi #  1   2 , G Nappo #  3   4 , M Pacilli  2 , G L Capretti  1   2 , P Spaggiari  5 , M Sollai  5 , S Bozzarelli  6 , A Zerbi  1   2
Affiliations

Pathologic tumor response to neoadjuvant therapy in resected pancreatic cancer: does it affect prognosis?

G Donisi et al. Updates Surg. 2023 Sep.

Abstract

Neoadjuvant therapy (NAT) + surgical resection for pancreatic cancer (PC) has gained consensus in recent years. Pathological response (PR) is generally assessed according to the College of American Pathologists grading system, ranging from 0 (complete response) to 3 (no response). The aim of our study is to evaluate the PR in a series of resections for PC after NAT and its prognostic implication. 112 patients undergone NAT and resection for PC between 2011 and 2020 were retrospectively evaluated. PR was 0/1, 2 and 3 in 18 (15%), 79 (61%) and 29 (24%) cases, respectively. Chemotherapy regimens different from FOLFIRINOX and gemcitabine + nab-paclitaxel (OR 11.61 (2.53-53.36), p = 0.002) and lymphovascular invasion (OR 11.28 (1.89-67.23), p = 0.008) were associated to PR-3. Median follow-up was 25.8 (3.6-130.5) months. For PR-0/1, PR-2 and PR-3, median DFS was 45.8, 11.5, 4.6 months (p < 0.0001), respectively, while median OS was not reached, 27.1 and 17.5 months (p = 0.0006), respectively. At univariate analysis, PR-0/1 was significantly associated to better DFS and OS (HR 0.33 (0.17-0.67), p = 0.002; HR 0.20 (0.07-0.54), p = 0.002, respectively). At multivariate analysis, pancreaticoduodenectomy (HR 0.50 (0.30-0.84), p = 0.009), LNR (HR 27.14 (1.21-608.9), p = 0.038) and lymphovascular invasion (HR 1.99 (1.06-3.76), p = 0.033) were independently associated to DFS; pre-treatment CA 19.9 value (HR 1.00 (1.00-1.00), p = 0.025), post-treatment resectability status (HR 0.51 (0.28-0.95), p = 0.035), pancreaticoduodenectomy (HR 0.56 (0.32-0.99), p = 0.050), severe morbidity (2.99 (1.22-7.55), p = 0.017), LNR (HR 56.8 (2.08-1548.3), p = 0.017), lymphovascular invasion (HR 2.18 (1.08-4.37), p = 0.029) were independently associated to OS. PR did not reach statistical significance at multivariate analysis. A favorable PR is observed only in a limited number of cases. The prognostic role of PR, despite being promising, remains unclear and further multicentric studies are needed.

Keywords: Neoadjuvant therapy; Pancreatic cancer; Pathological response; Prognostic factors.

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References

    1. O’Reilly EM, Ferrone C (2020) Neoadjuvant or adjuvant therapy for resectable or borderline resectable pancreatic cancer: which is preferred? J Clin Oncol 38(16):1763–1773. https://doi.org/10.1200/JCO.19.02274 - DOI
    1. Reames BN, Blair AB, Krell RW et al (2019) Management of locally advanced pancreatic cancer: results of an international survey of current practice. Ann Surg. https://doi.org/10.1097/SLA.0000000000003568 - DOI
    1. Nagakawa Y, Sahara Y, Hosokawa Y et al (2019) Clinical impact of neoadjuvant chemotherapy and chemoradiotherapy in borderline resectable pancreatic cancer: analysis of 884 patients at facilities specializing in pancreatic surgery. Ann Surg Oncol 26(6):1629–1636. https://doi.org/10.1245/s10434-018-07131-8 - DOI - PubMed
    1. Cloyd JM, Heh V, Pawlik TM et al (2020) Neoadjuvant therapy for resectable and borderline resectable pancreatic cancer: a meta-analysis of randomized controlled trials. J Clin Med 9(4):1129. https://doi.org/10.3390/jcm9041129 - DOI - PubMed - PMC
    1. van Dam JL, Janssen QP, Besselink MG et al (2022) Neoadjuvant therapy or upfront surgery for resectable and borderline resectable pancreatic cancer: A meta-analysis of randomised controlled trials. Eur J Cancer 160:140–149. https://doi.org/10.1016/j.ejca.2021.10.023 - DOI - PubMed

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