Pathologic Complete Response Is Associated with Good Prognosis in Patient with Pancreatic Ductal Adenocarcinoma Who Received Neoadjuvant Chemoradiation and Pancreatectomy.
Qing Zhao, Asif Rashid, Yun Gong, Matthew Katz, Jeffrey Lee, Robert Wolf, Chusilp Charnsangavej, Gauri Varadhachary, Peter Pisters, Eddie Abdalla, Jean-Nicolas Vauthey, Hua Wang, Henry Gomez, Jason Fleming, James Abbruzzese, Huamin Wang. MD Anderson Cancer Center, Houston, TX
Background: Patients with pancreatic ductal adenocarcinoma (PDA) has poor prognosis. To improve the clinical outcome, most patients with PDA are treated with neoadjuvant chemoradiation prior to surgery at our institution. In this group of patients, pathologic complete response (PCR) is rarely observed in subsequent pancreatectomies. However, the prognostic significance of PCR is not clear.
Design: Among 442 patients with PDA who received neoadjuvant chemoradiation and pancreatectomy from 1995 to 2010, 11 (2%) patients with PCR were identified. The cytologic diagnosis on pre-therapy tumor was reviewed and PCR in pancreatectomies was confirmed in all patients. Clinical and follow-up information were extracted from the medical records. Survival analysis was performed using the Kaplan-Meier method.
Results: There were 6 men and 5 women with age ranging from 43y to 75y (median: 61y). 4/11 (36%) patients had prior history of or synchronous extrapancreatic cancers, including one with lung cancer, one with breast cancer, one with prostate cancer and one with renal cell carcinoma. 5 patients received neoadjuvant chemotherapy followed by chemoradiation and 6 patient received chemoradiation. 10 patients had pancreaticoduodenectomy (PD) and one had distal pancreatectomy. These specimens were well sampled by histology and the entire pancreas was submitted for histology in 9 cases. On review, scar with fibrosis and chronic pancreatitis were present in all eleven cases. Carcinoma in situ was present in 2 cases and PanIN3 or PanIN2 in 4 cases. However, no residual viable invasive carcinoma cells or lymph node metastasis was identified in all cases. Follow-up information was available in 9/11 patients. Follow-up time ranges from 6M to 181M (median, 49M). During follow-up, four patients died, including one from brain metastasis of prior lung cancer, one from bone metastasis of breast cancer, one from sepsis, and one developed a second primary or recurrent PDA in the tail of pancreas at 84 M after PD and died of PDA at 105 M after the diagnosis of the initial PDA. The last patient had carcinoma in situ in the initial PD specimen. The other 5 patients were alive with no evidence of disease. Patients with PCR had better survival compared to the 240 patients who had residual viable PDA in pancreatectomy specimens after neoadjuvant therapy (p<0.001).
Conclusions: Patients with PDA who received neoadjuvant chemoradiation and had PCR in pancreatectomy is rare and is associated with better prognosis.
Category: Liver & Pancreas
Tuesday, March 1, 2011 1:00 PM
Poster Session IV # 215, Tuesday Afternoon