Lymph node metrics following neoadjuvant therapy to refine patient selection for adjuvant chemotherapy in resected pancreatic cancer: A multi‐institutional analysis
Year: 2024
Type: article
Study design: Observational Study
Abstract: BACKGROUND: In patients with localized pancreatic ductal adenocarcinoma (PDAC) undergoing neoadjuvant therapy (NAT) and resection, selection of adjuvant chemotherapy (AC) is typically guided by high-risk features on histopathologic examination. We evaluated the interaction between post-NAT lymph node metrics and AC receipt on survival. METHODS: Patients who received NAT followed by pancreatectomy (2010-2020) at seven centers were reviewed. Overall survival (OS) in patients receiving AC or not was stratified by lymph node positivity (LNP) or lymph node ratio (LNR) dichotomized at 0.1. Cox models evaluated the independent association between these nodal metrics, AC receipt, and OS. RESULTS: Of 464 patients undergoing NAT and resection, 264 (57%) received AC. Patients selected for AC were younger (median 63 vs. 67 years; p < 0.001), received shorter duration of NAT (2.8 vs. 3.2 months; p = 0.01), had fewer postoperative complications (Clavien-Dindo grade > 3: 1.2% vs. 11.7%; p < 0.001), and lower rates of pathologic complete response (4% vs. 11%; p = 0.01). The median number of nodes evaluated was similar between cohorts (n = 20 in both; p = 0.9). Post-NAT LNP rates were not different, and median LNR was 0.1, in AC and non-AC cohorts. Both LNP (hazard ratio [HR]: 2.1, p < 0.001) and LNR (0 < LNR ≤ 0.1: HR: 1.98, p = 0.002; LNR > 0.1: HR 2.46, p < 0.001) were independently associated with OS on Cox modeling, although receipt of AC was not associated with improved OS (median 30.6 vs. 29.4 months; p = 0.2). In patients with LNR > 0.1, receipt of AC was associated with significantly longer OS compared to non-AC (24 vs. 20 months, respectively; p = 0.04). CONCLUSIONS: LNR following NAT, not simply nodal positivity, may be useful to refine selection of AC in resected PDAC.
Source: Journal of Surgical Oncology
DOI: 10.1002/jso.27798
Authors: Haleh Amirian, Erin Dickey, Ifeanyichukwu Ogobuiro, Edmond W. Box, Ankit Shah, Mary P. Martos, Manan Patel, Gregory C. Wilson, Rebecca A. Snyder, Alexander A. Parikh, Chet Hammill, Hong J. Kim, Daniel Abbott, Shishir K. Maithel, Syed Nabeel Zafar, Michael T. LeCompte, David A. Kooby, Syed A. Ahmad, Nipun B. Merchant, Caitlin A. Hester, Jashodeep Datta
Institutions: University of Miami, Sylvester Comprehensive Cancer Center, University of Cincinnati, The University of Texas MD Anderson Cancer Center, East Carolina University, The University of Texas at San Antonio Health Science Center, Mays Cancer Center at UT Health San Antonio, Washington University in St. Louis, University of North Carolina at Chapel Hill, University of Wisconsin–Madison, Emory University
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,520
Funder: National Cancer Institute
OpenAlex ID: W4401728462