Abstract
Purpose
To investigate if a simplified image based scoring system assessing treatment response after neoadjuvant therapy (NAT) can predict survival in patients with pancreatic ductal adenocarcinoma (PDAC) who achieved subsequent R0 resection.
Methods
Retrospective analysis of 57 PDAC patients (male = 29, 51%) with mean age of 64 at diagnosis (range 42–79) who received NAT and R0 resection. Post-NAT overall, arterial and venous imaging response was characterized as improved, similar, or worse by 2 readers independently followed by consensus review. Kaplan–Meier Analysis was performed to compare overall survival (OS) with post-NAT overall imaging response. A Multivariable Cox proportional hazards analysis was performed to evaluate the association of the following variables with OS: overall, arterial and venous radiology response, clinical staging, postoperative CA19-9, and patient age.
Results
At study conclusion, 30/57 patients were deceased (53%), 26/57 (46%) alive, and 1 patient unknown. Post-NAT, 39/57 (68.4%) had overall improved disease and 18/57 (31.6%) had similar disease. The median OS was 55.7 months (95% CI 33.4–not reached, NR) for those with improved disease vs. 53.9 months (95% CI 14.3–NR) with similar disease (p = 0.859) after NAT. Among all clinical parameters, only post-operative CA 19-9 level was associated with OS (p = 0.002) and PFS (p = 0.005), respectively.
Conclusion
Pancreatic cancer patients who underwent R0 resection showed no difference in survival when comparing those with similar vs improved disease on post-NAT imaging.
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Data availability
Available upon request.
Code availability
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References
Siegel, R.L., K.D. Miller, and A. Jemal, Cancer statistics, 2020. CA Cancer J Clin, 2020. 70(1): p. 7-30.
Simoes, P.K., et al., Epidemiology of pancreatic adenocarcinoma. Chin Clin Oncol, 2017. 6(3): p. 24.
McGuigan, A., et al., Pancreatic cancer: A review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol, 2018. 24(43): p. 4846-4861.
van Veldhuisen, E., et al., Locally Advanced Pancreatic Cancer: Work-Up, Staging, and Local Intervention Strategies. Cancers (Basel), 2019. 11(7).
Ducreux, M., et al., Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2015. 26 Suppl 5: p. v56-68.
Versteijne, E., et al., Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial. J Clin Oncol, 2020. 38(16): p. 1763-1773.
Versteijne, E., et al., Preoperative radiochemotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer (PREOPANC trial): study protocol for a multicentre randomized controlled trial. Trials, 2016. 17(1): p. 127.
Ghaneh, P., et al., The Impact of Positive Resection Margins on Survival and Recurrence Following Resection and Adjuvant Chemotherapy for Pancreatic Ductal Adenocarcinoma. Ann Surg, 2019. 269(3): p. 520-529.
Daamen, L.A., et al., Microscopic resection margin status in pancreatic ductal adenocarcinoma - A nationwide analysis. Eur J Surg Oncol, 2020.
Kaltenmeier, C., et al., Impact of Resection Margin Status in Patients with Pancreatic Cancer: a National Cohort Study. J Gastrointest Surg, 2020.
Tummers, W.S., et al., Impact of resection margin status on recurrence and survival in pancreatic cancer surgery. Br J Surg, 2019. 106(8): p. 1055-1065.
Tempero, M.A., et al., Pancreatic Adenocarcinoma, Version 1.2019. J Natl Compr Canc Netw, 2019. 17(3): p. 202–210.
Hue, J.J., et al., Neoadjuvant chemoradiation may be associated with improved pathologic response in pancreatic cancer. Am J Surg, 2020.
Murphy, J.E., et al., Total Neoadjuvant Therapy With FOLFIRINOX Followed by Individualized Chemoradiotherapy for Borderline Resectable Pancreatic Adenocarcinoma: A Phase 2 Clinical Trial. JAMA Oncol, 2018. 4(7): p. 963-969.
Wolfe, A.R., et al., Neoadjuvant-modified FOLFIRINOX vs nab-paclitaxel plus gemcitabine for borderline resectable or locally advanced pancreatic cancer patients who achieved surgical resection. Cancer Med, 2020. 9(13): p. 4711-4723.
Reni, M., et al., Selecting patients for resection after primary chemotherapy for non-metastatic pancreatic adenocarcinoma. Ann Oncol, 2017. 28(11): p. 2786-2792.
Janssen, Q.P., et al., Total neoadjuvant FOLFIRINOX versus neoadjuvant gemcitabine-based chemoradiotherapy and adjuvant gemcitabine for resectable and borderline resectable pancreatic cancer (PREOPANC-2 trial): study protocol for a nationwide multicenter randomized controlled trial. BMC Cancer, 2021. 21(1): p. 300.
Wang, Z.J., et al., Therapeutic response assessment in pancreatic ductal adenocarcinoma: society of abdominal radiology review paper on the role of morphological and functional imaging techniques. Abdom Radiol (NY), 2020. 45(12): p. 4273-4289.
Joo, I., et al., Preoperative MDCT Assessment of Resectability in Borderline Resectable Pancreatic Cancer: Effect of Neoadjuvant Chemoradiation Therapy. AJR Am J Roentgenol, 2018. 210(5): p. 1059-1065.
Wagner, M., et al., CT evaluation after neoadjuvant FOLFIRINOX chemotherapy for borderline and locally advanced pancreatic adenocarcinoma. Eur Radiol, 2017. 27(7): p. 3104-3116.
Cassinotto, C., A. Sa-Cunha, and H. Trillaud, Radiological evaluation of response to neoadjuvant treatment in pancreatic cancer. Diagn Interv Imaging, 2016. 97(12): p. 1225-1232.
Ferrone, C.R., et al., Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg, 2015. 261(1): p. 12-7.
Chang, S.T., et al., Preoperative Multidetector CT Diagnosis of Extrapancreatic Perineural or Duodenal Invasion Is Associated with Reduced Postoperative Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma: Preliminary Experience and Implications for Patient Care. Radiology, 2016. 281(3): p. 816-825.
Roche, C.J., et al., CT and pathologic assessment of prospective nodal staging in patients with ductal adenocarcinoma of the head of the pancreas. AJR Am J Roentgenol, 2003. 180(2): p. 475-80.
Diehl, S.J., et al., Pancreatic cancer: value of dual-phase helical CT in assessing resectability. Radiology, 1998. 206(2): p. 373-8.
Al-Hawary, M.M., et al., Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association. Radiology, 2014. 270(1): p. 248-60.
Crewson, P.E., Reader agreement studies. AJR Am J Roentgenol, 2005. 184(5): p. 1391-7.
Imbriaco, M., et al., Dual-phase versus single-phase helical CT to detect and assess resectability of pancreatic carcinoma. AJR Am J Roentgenol, 2002. 178(6): p. 1473-9.
Conroy, T., et al., FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med, 2011. 364(19): p. 1817-25.
Conroy, T., et al., FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer. N Engl J Med, 2018. 379(25): p. 2395-2406.
Cecchini, M., et al., A Single-Institution Experience of Induction 5-Fluorouracil, Leucovorin, Irinotecan, and Oxaliplatin Followed by Surgery Versus Consolidative Radiation for Borderline and Locally Advanced Unresectable Pancreatic Cancer. Pancreas, 2020. 49(7): p. 904-911.
Cassinotto, C., et al., An evaluation of the accuracy of CT when determining resectability of pancreatic head adenocarcinoma after neoadjuvant treatment. Eur J Radiol, 2013. 82(4): p. 589-93.
Katz, M.H., et al., Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer, 2012. 118(23): p. 5749-56.
Dudeja, V., et al., Neoadjuvant chemoradiotherapy for locally advanced pancreas cancer rarely leads to radiological evidence of tumour regression. HPB (Oxford), 2013. 15(9): p. 661-7.
Cassinotto, C., et al., Locally advanced pancreatic adenocarcinoma: reassessment of response with CT after neoadjuvant chemotherapy and radiation therapy. Radiology, 2014. 273(1): p. 108-16.
Joo, I., et al., Preoperative CT Classification of the Resectability of Pancreatic Cancer: Interobserver Agreement. Radiology, 2019. 293(2): p. 343-349.
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Guo, Y., Czeyda-Pommersheim, F., Miccio, J.A. et al. Can a simplified CT response criteria for vascular involvement in pancreatic adenocarcinoma after neoadjuvant therapy predict survival in patients who achieved subsequent R0 resection?. Abdom Radiol 46, 5609–5617 (2021). https://doi.org/10.1007/s00261-021-03284-5
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DOI: https://doi.org/10.1007/s00261-021-03284-5