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The Addition of Postoperative Chemotherapy is Associated with Improved Survival in Patients with Pancreatic Cancer Treated with Preoperative Therapy

  • Pancreatic Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Preoperative/neoadjuvant therapy (NT) is increasingly utilized for the treatment of pancreatic ductal adenocarcinoma (PDAC). However, little data exist regarding information on the use of additional postoperative therapy following NT. The lymph node ratio (LNR) is a prognostic marker of oncologic outcomes after NT and resection. In this study, we evaluated the effectiveness of postoperative therapy following NT, stratified by LNR.

Methods

A prospective tumor registry database was queried to identify patients with PDAC who underwent resection following NT from 1990 to 2008. Clinicopathologic factors were compared to identify associations with overall survival (OS) and time to recurrence (TTR) based on postoperative chemotherapy status.

Results

Thirty-six (14 %) of the 263 patients received additional postoperative therapy. No differences were observed in the pathologic characteristics between patients who received postoperative chemotherapy and those who did not. The median LNR was 0.12 for patients with N + disease. Following NT, the administration of postoperative therapy was associated with improved median OS (72 vs. 33 months; p = 0.008) for patients with an LNR < 0.15. There was no association between postoperative chemotherapy and OS for patients with LNR ≥ 0.15. Multivariate analysis demonstrated that the administration of postoperative systemic therapy in patients with a low LNR was associated with a reduced risk of death (hazard ratio 0.49; p = 0.02).

Conclusion

Postoperative chemotherapy after NT in patients with low LNR is associated with improved oncologic outcomes.

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Acknowledgment

This research has been supported by the Khalifa Bin Zayed Al Nahyan Foundation and the various donor Pancreatic Cancer Research Funds at the University of Texas MD Anderson Cancer Center, the Ruth L. Kirschstein National Research Service Award NIH T32 CA009599, and the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30CA016672. We thank Mano Sundar for her management of our departmental pancreatic cancer database.

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Christina L. Roland MD, Matthew H. G. Katz MD, Ching-Wei D. Tzeng MD, Jean N. Vauthey MD, Jeffrey E. Lee MD & Jason B. Fleming MD

  2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Heather Lin PhD

  3. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Gauri R. Varadhachary MD, Rachna Shroff MD, Milind Javle MD, David Fogelman MD & Robert A. Wolff MD

  4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Christopher H. Crane MD

  5. Department of Surgery, University of Kentucky, Lexington, KY, USA

    Ching-Wei D. Tzeng MD

Authors
  1. Christina L. Roland MD
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  2. Matthew H. G. Katz MD
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  3. Ching-Wei D. Tzeng MD
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  4. Heather Lin PhD
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  5. Gauri R. Varadhachary MD
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  6. Rachna Shroff MD
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  7. Milind Javle MD
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  8. David Fogelman MD
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  9. Robert A. Wolff MD
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  10. Jean N. Vauthey MD
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  11. Christopher H. Crane MD
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  12. Jeffrey E. Lee MD
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  13. Jason B. Fleming MD
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Corresponding author

Correspondence to Christina L. Roland MD.

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Roland, C.L., Katz, M.H.G., Tzeng, CW.D. et al. The Addition of Postoperative Chemotherapy is Associated with Improved Survival in Patients with Pancreatic Cancer Treated with Preoperative Therapy. Ann Surg Oncol 22 (Suppl 3), 1221–1228 (2015). https://doi.org/10.1245/s10434-015-4854-z

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  • DOI: https://doi.org/10.1245/s10434-015-4854-z

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