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Cited by 112Pancreatic and Hepatic Oncology ResearchCholangiocarcinoma and Gallbladder Cancer StudiesMRI in cancer diagnosis

Association of clinical factors with a major pathologic response following preoperative therapy for pancreatic ductal adenocarcinoma

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Cloyd, Jordan M., Wang, Huamin, Egger, Michael E., Tzeng, Ching-Wei D., Prakash, Laura R., Maitra, Anirban, Varadhachary, Gauri R., Shroff, Rachna +13 more·2017·JAMA Surgery
DOI 10.1001/jamasurg.2017.2227PMC PMC5710421
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Abstract

IMPORTANCE: We previously demonstrated that a major pathologic response to preoperative therapy, defined histopathologically by the presence of less than 5% viable cancer cells in the surgical specimen, is an important prognostic factor for patients with pancreatic ductal adenocarcinoma. However, to our knowledge, the patients most likely to experience a significant response to therapy are undefined. OBJECTIVE: To identify clinical factors associated with major pathologic response in a large cohort of patients who underwent preoperative therapy and pancreatectomy for pancreatic ductal adenocarcinoma. DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of a prospectively maintained database at University of Texas MD Anderson Cancer Center. The study included 583 patients with histopathologically confirmed pancreatic ductal adenocarcinoma who received preoperative therapy prior to pancreatectomy between 1990 and 2015. EXPOSURES: Preoperative therapy consisted of systemic chemotherapy alone (n = 38; 6.5%), chemoradiation alone (n = 261; 44.8%), or both (n = 284; 48.7%) prior to pancreatoduodenectomy (n = 514; 88.2%), distal pancreatectomy (n = 62; 10.6%), or total pancreatectomy (n = 7; 1.2%). MAIN OUTCOMES AND MEASURES: Clinical variables associated with a major pathologic response (pathologic complete response or <5% residual cancer cells) were evaluated using logistic regression. RESULTS: Among all patients, the mean (SD) age was 63.7 (9.2) years, and 53.0% were men. A major pathologic response was seen in 77 patients (13.2%) including 23 (3.9%) who had a complete pathologic response. The median overall survival duration was significantly longer for patients who had a major response than for those who did not (73.4 months vs 32.2 months, P < .001). On multivariate logistic regression, only age younger than 50 years, baseline serum cancer antigen 19-9 level less than 200 U/mL, and gemcitabine as a radiosensitizer were associated with a major response. The number of these positive factors was associated with the likelihood of a major response in a stepwise fashion (0, 7.5%; 1, 12.7%; 2, 16.9%; 3, 35.7%; P = .009). CONCLUSIONS AND RELEVANCE: Although a major pathologic response occurs infrequently following preoperative therapy for pancreatic ductal adenocarcinoma, it is associated with a significantly improved prognosis. Of the patient- and treatment-related factors we analyzed, only young age, low baseline cancer antigen 19-9, and gemcitabine as a radiosensitizer were associated with a major pathologic response. Given its association with long-term survival, better predictors of response and more effective preoperative regimens should be aggressively sought.

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  • Patients with major or complete pathological response to neoadjuvant therapy have significantly improved overall survival.

    “patients whose PDAC exhibits a major or complete pathological response to neoadjuvant therapy demonstrate significantly improved overall survival17”

    From Pancreatic cancer: Advances and challenges (2023) · cites this paper as [17]

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Authors
Cloyd, J. M., Wang, H., Egger, M. E., Tzeng, C.-W. D., Prakash, L. R., Maitra, A., Varadhachary, G. R., Shroff, R., Javle, M., Fogelman, D., Wolff, R. A., Overman, M. J., Koay, E. J., Das, P., Herman, J. M., Kim, M. P., Vauthey, J.-N., Aloia, T. A., Fleming, J. B., Lee, J. E., & Katz, M. H. G.
Affiliations
The University of Texas MD Anderson Cancer Center (US)
Corresponding author
Katz, Matthew H. G.
ORCID
Venue
JAMA Surgery
Publisher
American Medical Association (AMA)
Published
2017-11-01
Volume
152
Issue
11
Pages
1048
ISSN
2168-6254 (ISSN-L)
DOI
10.1001/jamasurg.2017.2227
PMC
PMC5710421
OpenAlex
W2735284619
Cited by
112
References
43
Citations by year
2026: 3 · 2025: 12 · 2024: 14 · 2023: 12 · 2022: 7 · 2021: 16 · 2020: 19 · 2019: 12 · 2018: 11 · 2017: 5
FWCI
5.67
Type
journal article
Language
en
Open access
Locations
  • JAMA Surgery (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
  • Health Sciences › Medicine › Surgery › Cholangiocarcinoma and Gallbladder Cancer Studies
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › MRI in cancer diagnosis
Keywords
pancreatic ductal adenocarcinoma, neoadjuvant therapy, major pathological response, pathological complete response, prognostic factors, gemcitabine, CA19-9, age, chemoradiotherapy, pancreatic resection, overall survival, residual tumor cells, radiosensitizers, distal pancreatectomy, total pancreatectomy, pancreaticoduodenectomy
MeSH terms
Gemcitabine, Adult, Age Factors, Aged, Antigens, Neoplasm, Antineoplastic Agents, Deoxycytidine, Female, Humans, Male, Middle Aged, Pancreatic Neoplasms, Radiation-Sensitizing Agents, Retrospective Studies, Biomarkers, Tumor, Multivariate Analysis, Survival Analysis, Carcinoma, Pancreatic Ductal, Preoperative Period, Chemoradiotherapy

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