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PATHOLOGIC RESPONSE TO CHEMOTHERAPY MAY NOT CORRELATE WITH SURVIVAL IN PATIENTS WITH COMBINED PANCREATIC AND CELIAC RESECTION AFTER NEOADJUVANT THERAPY
Andrea Porpiglia*2, Senthil Jayarajan3, Harry Cooper1, Sanjay S. Reddy1, John P. Hoffman1, Andreas Karachristos1
1Fox Chase Cancer Center, Philadelphia, PA; 2Surgery, Crozer Keystone Health Network, Drexel Hill, PA; 3Washington University, Saint Louis, MO
Introduction: Major pathologic response after neoadjuvant therapy has been associated with improved outcomes in patients with pancreatic cancer. The purpose of this study is to analyze the survival of patients with combined pancreatic and celiac resection after neoadjuvant therapy according to pathologic response.
Methods: We reviewed a prospective database of patients with pancreatic adenocarcinoma and celiac axis involvement treated with chemoradiation and chemotherapy followed by resection from 1995-2014. Histopathology was performed in all specimens to identify major response to neoadjuvant therapy as defined by fibrosis ≥95%. Survival curves were generated using Kaplan-Meier method and compared with the log-rank test. Survival was calculated from the day of diagnosis.
Results: The study included 14 consecutive patients from 1995 to 2014 operated by the authors. One patient expired two months after resection and was excluded from the analysis. All received neoadjuvant radiation with concurrent Gemcitabine, 5FU or Xeloda. Four patients received neoadjuvant gemcitabine- based chemotherapy followed by chemoradiation. There were 7 women. Four patients had Whipple procedures, 3 had total pancreatectomies and 7 had subtotal pancreatectomies. Nine patients needed liver revascularization. Three patients had fibrosis ≥ 95%. Median survival from diagnosis for the entire cohort was 25 months. There was no difference found in disease free or overall survival between groups. Overall survival is shown in the figure.
Conclusions: Major pathologic response to preoperative therapy does not correlate with survival in patients with pancreatic adenocarcinoma with involvement and resection of the celiac axis. The results may well have been influenced by the small size of our cohort. Furthermore the majority of patients did not receive preoperative chemotherapy or more modern chemotherapy. Further experience with more patients treated with prolonged modern chemotherapy may well change our findings so that they correlate to experience with patients with neoadjuvant therapy without celiac resection.
Figure 1. Overall survival curve. "High indicates major response and "low" moderate and poor response.
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