Prognostic value of major pathological response following neoadjuvant therapy for non resectable pancreatic ductal adenocarcinoma |
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| Institution: | 1. Hepatopancreatobiliary Surgery Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy;2. General Surgery 3, Department of Surgical Oncological and Gastroenterological Sciences, University of Padova, Italy;3. Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy;4. Pathology Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy;5. Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy;1. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland;2. Faculty of Medicine and Health Technology, Tampere University, Finland;3. Department of Surgery, Oslo University Hospital, Oslo, Norway;4. Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania;5. Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark;6. Department of Gastroenterology, Haukeland University Hospital, Norway;7. Department of Clinical Medicine, University of Bergen, Norway;8. Division of Gastroenterology, Digestive Disease Center K, Bispebjerg Hospital, Copenhagen, Denmark;9. Herlev Copenhagen University Hospital/Herlev, University of Copenhagen, Copenhagen, Denmark;10. Pancreatitis Centre East (PACE), Copenhagen University Hospital Hvidovre, Copenhagen, Denmark;1. Department of Radiology, Peking Union Medical College Hospital, Beijing, China;2. Department of General Surgery, Peking Union Medical College Hospital, Beijing, China;3. Department of Pathology, Peking Union Medical College Hospital, Beijing, China;1. Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA;2. Department of Surgery, Fukuoka University Chikushi Hospital, Japan;3. Department of Surgery and Oncology, Kyushu University, Japan;4. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Japan;5. Department of General Surgery, Chiba University, Japan;6. NYU Health Sciences Library, NYU Langone Health, NYU Grossman School of Medicine, USA;7. Department of Surgery, NYU Langone Health, USA;1. Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA;2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA;3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA;1. Department of Hepatobiliary, Pancreatic and Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;2. College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK |
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| Abstract: | BackgroundThe aim of this study is to evaluate the impact of major pathological response on overall survival (OS) in borderline resectable and locally advanced pancreatic ductal adenocarcinoma following neoadjuvant treatment, and to identify predictors of major pathological response.MethodsPatients surgically resected following neoadjuvant treatment between 2010 and 2020 at the Pederzoli Hospital were retrospectively analyzed. Pathologic response was assessed using the College of American Pathologists (CAP) score, and major pathological response was defined as CAP 0–1. OS was estimated and compared using the Kaplan-Meier method and log-rank test. A logistic and Cox regression model were performed to identify predictors of major pathologic response and OS.ResultsOverall, 200 patients were included in the study. A major and complete pathological response were observed in 52(26.0%) and 15(7.3%) patients respectively. The 1-, 3-, 5-year OS was 92.7, 67.2, and 41.7%, and 71.0, 37.4, and 20.8% in patients with or without major pathologic response respectively (log-rank test p < 0.001). Major pathologic response was confirmed as independent predictor of OS (OR 0.50 95%CI 0.29–0.88, p = 0.01). Post-treatment CA19-9 normalization (OR 4.20 95%CI 1.14–10.35, p = 0.02) and radiological post-treatment tumor residual size<25 mm (OR 2.71 95%CI 1.27–5.79, p = 0.01) were found to be independent predictors of major pathologic response.ConclusionPatients experienced a major pathological response after neoadjuvant treatment have an increased survival, and major pathologic response is an independent predictor of OS. A normal CA19-9 value and radiological tumor size at restaging are confirmed to be independent predictors of major pathologic response. |
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| Keywords: | Neoadjuvant treatment Pancreatic adenocarcinoma Major pathologic response |
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