SSAT - IMPACT OF NODAL STATUS ON ADJUVANT THERAPY FOR PATIENTS WITH LOCALIZED PANCREATIC CANCER TREATED WITH NEOADJUVANT THERAPY

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IMPACT OF NODAL STATUS ON ADJUVANT THERAPY FOR PATIENTS WITH LOCALIZED PANCREATIC CANCER TREATED WITH NEOADJUVANT THERAPY
Chad Barnes^*, Mohammed Aldakkak, Kathleen Christians, Abdul H. Khan, Kiyoko Oshima, Paul S. Ritch, Ben George, William Hall, Beth A. Erickson, Douglas B. Evans, Susan Tsai
Medical College of Wisconsin, Milwaukee, WI

Background: Among patients with localized pancreatic cancer (PC) who undergo upfront surgery, adjuvant therapy improves overall survival (OS) as compared to observation. The impact of adjuvant therapy after neoadjuvant therapy and surgery has not been well described.
Methods: Details regarding adjuvant treatment were collected from patients with resectable and borderline resectable PC who completed all intended neoadjuvant therapy and surgery. Patients were categorized by pathologic nodal status (LN+/LN-) and receipt of any adjuvant therapy.
Results: Data was available from 217 consecutive patients, 110 (51%) with resectable and 107 (49%) with borderline resectable PC. Of the 217 patients, 83 (38%) were LN+ and 134 (62%) were LN-. Of the 83 LN+ patients, 57 (69%) received adjuvant therapy and 26 (31%) did not. Of the134 LN- patients, 73 (54%) received adjuvant therapy and 61 (46%) did not. The median OS for the 217 patients was 40 months; 45 months for patients who received any adjuvant therapy and 34 months for those who did not (p=0.15). Of the 83 LN+ patients, the median OS was 39 months with adjuvant therapy and 23 months without (p=0.05). Of the134 LN- patients, the median OS was 45 months with adjuvant therapy and 43 months without (p=0.40). In an adjusted hazards model, the receipt of adjuvant therapy had a greater protective effect among LN+ patients (HR:0.40; 95%CI:0.18-0.88, p=0.02) compared to LN- patients (HR:0.72; 95%CI:0.41-1.24, p=0.23).
Conclusion: Among patients with localized PC who have received neoadjuvant therapy and surgery, the effect of adjuvant therapy varies based on nodal status, and patients with LN+ disease experience the greatest survival benefit. The benefit of adjuvant therapy for patients with LN- disease after neoadjuvant therapy should be investigated in larger cohorts, as the benefit of such treatment may be quite low.

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