Histopathological tumour viability after neoadjuvant chemotherapy influences survival in resected pancreatic cancer: analysis of early outcome data.
BACKGROUND
Neoadjuvant therapy is increasingly recognized as an effective strategy prior to pancreatoduodenectomy. We investigate the role of neoadjuvant chemotherapy (NAC) followed by surgery and the predictive role of viable residual tumour cells histopathologically on outcomes.


METHODS
The study population comprised of 195 consecutive patients with pancreatic adenocarcinoma who were treated with either NAC or a surgery-first (SF) strategy. Histopathological viable tumour cells were examined in the NAC patients and clinicopathological factors were correlated with overall survival.


RESULTS
Forty-two patients (22%) were treated with NAC and 153 patients (78%) underwent SF. NAC was associated with higher estimated blood loss during surgery (928 mL versus 615 mL; P = 0.004), fewer (<15) excised lymph nodes (37% versus 17%; P = 0.015) and lower rates of lymphovascular invasion (65% versus 45%; P = 0.044) when compared with SF. Two-year survival of patients undergoing NAC was 63% and 51% in patients undergoing SF (P = 0.048). The 2-year survival of patients who had >65% residual tumour cells was 45% and 90% in patients who had <65% residual tumour cells (P = 0.022). Favourable responders (<65% viable tumour cells) were observed to have shorter operation time (<420 min) (55% versus 13%; P = 0.038), trend towards negative lymph node status (38% versus 10%; P = 0.067) and greater lymph node harvest in node positive patients (≥4 positive lymph nodes) (77% versus 37%; P = 0.045).


CONCLUSIONS
The improved survival of patients undergoing NAC indicates effective management of micrometastatic disease and is an effective option requiring further investigation. Histopathological viable tumour cells after NAC was a surrogate marker for survival.
Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
Phil
P
Townend
Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
Phil R
PR
de Reuver
Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
Terence C
TC
Chua
Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
Anubhav
A
Mittal
Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Stephen J
SJ
Clark
Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Nick
N
Pavlakis
Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Sydney, New South Wales, Australia.|Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|Deparment of Anatomical Pathology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Anthony J
AJ
Gill
Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Macquarie University Hospital, Macquarie University, Sydney, New South Wales, Australia.
Jaswinder S
JS
Samra
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
lymph node; metastasis; neoadjuvant chemotherapy; pancreatic cancer; pancreatoduodenectomy; prognostic factors