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


CONCLUSIONS
Postoperative chemotherapy after NT in patients with low LNR is associated with improved oncologic outcomes.
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. clroland@mdanderson.org.
Christina L
CL
Roland
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Matthew H G
MH
Katz
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of Surgery, University of Kentucky, Lexington, KY, USA.
Ching-Wei D
CW
Tzeng
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Heather
H
Lin
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Gauri R
GR
Varadhachary
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Rachna
R
Shroff
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Milind
M
Javle
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
David
D
Fogelman
Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Robert A
RA
Wolff
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Jean N
JN
Vauthey
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Christopher H
CH
Crane
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Jeffrey E
JE
Lee
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Jason B
JB
Fleming
D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000401:mortality*; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D011182:Postoperative Care; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate