Posttherapy Pathologic Stage and Number of Positive Lymph Nodes Predict Survival in Patients with Pancreatic Ductal Adenocarcinoma Treated with Neoadjuvant Chemoradiation.
Jeannelyn S Estrella, Asif Rashid, Matthew H Katz, Jeffrey E Lee, Robert A Wolf, Gauri R Varadhachary, Peter WT Pisters, Eddie K Abdalla, Jean-Nicolas Vauthey, Hua Wang, Henry F Gomez, Douglas B Evans, Jason B Fleming, James L Abbruzzese, Huamin Wang. U.T. M.D. Anderson Cancer Center, Houston, TX; The Medical College of Wisconsin, Milwaukee, WI
Background: Pancreatic ductal adenocarcinoma (PDAC) remains a deadly disease despite recent advances in oncology and operative techniques. The addition of post-operative chemoradiation demonstrated very modest improvement in survival. In our institution, most patients with PDAC are treated with chemoradiation prior to surgery. Neoadjuvant chemoradiation identifies patients who would likely benefit the most from surgery, provides early treatment of micrometastatic disease, and reduces tumor volume. However, analysis of prognostic factors influencing survival is lacking in patients with PDAC treated with neoadjuvant chemoradiation and subsequent pancreaticoduodenectomy (PD).
Design: The study population comprised of 240 consecutive patients with PDAC who received different neoadjuvant chemotherapy/radiation therapy regimens and underwent pancreaticoduodenectomy (PD) between January 1999 and December 2007. Clinicopathologic features were correlated with disease-free and overall survival using Kaplan-Meier method and Cox regression analysis.
Results: Among 240 patients treated with neoadjuvant chemoradiation followed by PD, the median disease-free and overall survival times were 15.1 and 33.5 months, respectively. There was no significant difference in disease-free and overall survival among patients who received different neoadjuvant chemoradiation regimens. In univariate analysis, disease-free survival was associated with age (p=0.002), posttherapy tumor stage (ypT) (p<0.03), regional lymph node status (ypN) (p<0.001), number of positive lymph nodes (p<0.001), and pathologic AJCC stage (p=0.001), while overall survival was associated with intraoperative blood loss (p<0.03), margin status (p=0.02), ypT (p=0.005), ypN (p<0.001), number of positive lymph nodes (p<0.001), and pathologic AJCC stage (p<0.001). By multivariate analysis, disease-free survival was independently associated with age (p=0.004), number of positive lymph nodes (p=0.01), and AJCC stage (p=0.002) and overall survival was independently associated with differentiation (p<0.04), margin status (p=0.04), number of positive lymph nodes (p=0.001), and AJCC stage (p<0.001).
Conclusions: In patients with PDAC who were treated with neoadjuvant chemoradiation and subsequent PD, posttherapy pathologic stage and number of positive lymph nodes are significant independent prognostic factors for both disease-free and overall survival.
Category: Liver & Pancreas
Monday, February 28, 2011 2:00 PM
Platform Session: Section D, Monday Afternoon