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Pathologic tumor response to neoadjuvant therapy in resected pancreatic cancer: does it affect prognosis?

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Abstract

Neoadjuvant therapy (NAT) + surgical resection for pancreatic cancer (PC) has gained consensus in recent years. Pathological response (PR) is generally assessed according to the College of American Pathologists grading system, ranging from 0 (complete response) to 3 (no response). The aim of our study is to evaluate the PR in a series of resections for PC after NAT and its prognostic implication. 112 patients undergone NAT and resection for PC between 2011 and 2020 were retrospectively evaluated. PR was 0/1, 2 and 3 in 18 (15%), 79 (61%) and 29 (24%) cases, respectively. Chemotherapy regimens different from FOLFIRINOX and gemcitabine + nab-paclitaxel (OR 11.61 (2.53–53.36), p = 0.002) and lymphovascular invasion (OR 11.28 (1.89–67.23), p = 0.008) were associated to PR-3. Median follow-up was 25.8 (3.6–130.5) months. For PR-0/1, PR-2 and PR-3, median DFS was 45.8, 11.5, 4.6 months (p < 0.0001), respectively, while median OS was not reached, 27.1 and 17.5 months (p = 0.0006), respectively. At univariate analysis, PR-0/1 was significantly associated to better DFS and OS (HR 0.33 (0.17–0.67), p = 0.002; HR 0.20 (0.07–0.54), p = 0.002, respectively). At multivariate analysis, pancreaticoduodenectomy (HR 0.50 (0.30–0.84), p = 0.009), LNR (HR 27.14 (1.21–608.9), p = 0.038) and lymphovascular invasion (HR 1.99 (1.06–3.76), p = 0.033) were independently associated to DFS; pre-treatment CA 19.9 value (HR 1.00 (1.00–1.00), p = 0.025), post-treatment resectability status (HR 0.51 (0.28–0.95), p = 0.035), pancreaticoduodenectomy (HR 0.56 (0.32–0.99), p = 0.050), severe morbidity (2.99 (1.22–7.55), p = 0.017), LNR (HR 56.8 (2.08–1548.3), p = 0.017), lymphovascular invasion (HR 2.18 (1.08–4.37), p = 0.029) were independently associated to OS. PR did not reach statistical significance at multivariate analysis. A favorable PR is observed only in a limited number of cases. The prognostic role of PR, despite being promising, remains unclear and further multicentric studies are needed.

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  1. G. Donisi and G. Nappo have equally contributed to this work.

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  1. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy

    G. Donisi, G. Nappo, G. L. Capretti & A. Zerbi

  2. Pancreatic Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Milan, Rozzano, Italy

    G. Donisi, G. Nappo, M. Pacilli, G. L. Capretti & A. Zerbi

  3. Department of Pathology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Milan, Rozzano, Italy

    P. Spaggiari & M. Sollai

  4. Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Milan, Rozzano, Italy

    S. Bozzarelli

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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by GD and GN. The first draft of the manuscript was written by GD and GN and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (all authors).

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Donisi, G., Nappo, G., Pacilli, M. et al. Pathologic tumor response to neoadjuvant therapy in resected pancreatic cancer: does it affect prognosis?. Updates Surg 75, 1497–1508 (2023). https://doi.org/10.1007/s13304-023-01628-y

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