Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2015

01-12-2015 | Pancreatic Tumors

The Addition of Postoperative Chemotherapy is Associated with Improved Survival in Patients with Pancreatic Cancer Treated with Preoperative Therapy

Authors: Christina L. Roland, MD, Matthew H. G. Katz, MD, Ching-Wei D. Tzeng, MD, Heather Lin, PhD, Gauri R. Varadhachary, MD, Rachna Shroff, MD, Milind Javle, MD, David Fogelman, MD, Robert A. Wolff, MD, Jean N. Vauthey, MD, Christopher H. Crane, MD, Jeffrey E. Lee, MD, Jason B. Fleming, MD

Published in: Annals of Surgical Oncology | Special Issue 3/2015

Login to get access

Abstract

Background

Preoperative/neoadjuvant therapy (NT) is increasingly utilized for the treatment of pancreatic ductal adenocarcinoma (PDAC). However, little data exist regarding information on the use of additional postoperative therapy following NT. The lymph node ratio (LNR) is a prognostic marker of oncologic outcomes after NT and resection. In this study, we evaluated the effectiveness of postoperative therapy following NT, stratified by LNR.

Methods

A prospective tumor registry database was queried to identify patients with PDAC who underwent resection following NT from 1990 to 2008. Clinicopathologic factors were compared to identify associations with overall survival (OS) and time to recurrence (TTR) based on postoperative chemotherapy status.

Results

Thirty-six (14 %) of the 263 patients received additional postoperative therapy. No differences were observed in the pathologic characteristics between patients who received postoperative chemotherapy and those who did not. The median LNR was 0.12 for patients with N + disease. Following NT, the administration of postoperative therapy was associated with improved median OS (72 vs. 33 months; p = 0.008) for patients with an LNR < 0.15. There was no association between postoperative chemotherapy and OS for patients with LNR ≥ 0.15. Multivariate analysis demonstrated that the administration of postoperative systemic therapy in patients with a low LNR was associated with a reduced risk of death (hazard ratio 0.49; p = 0.02).

Conclusion

Postoperative chemotherapy after NT in patients with low LNR is associated with improved oncologic outcomes.
Literature
1.
Tzeng CW, Tran Cao HS, Lee JE, et al. Treatment sequencing for resectable pancreatic cancer: influence of early metastases and surgical complications on multimodality therapy completion and survival. J Gastrointest Surg. 2014;18(1):16–24.PubMedCrossRef
2.
Katz MH, Wang H, Fleming JB, et al. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol. 2009;16(4):836–47.PubMedPubMedCentralCrossRef
3.
Bilimoria KY, Bentrem DJ, Ko CY, et al. Multimodality therapy for pancreatic cancer in the U.S: utilization, outcomes, and the effect of hospital volume. Cancer. 2007;110(6):1227–34.PubMedCrossRef
4.
Colbert LE, Hall WA, Nickleach D, et al. Chemoradiation therapy sequencing for resected pancreatic adenocarcinoma in the National Cancer Data Base. Cancer. 2014;120(4):499–506.PubMedPubMedCentralCrossRef
5.
Varadhachary GR, Wolff RA, Crane CH, et al. Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26(21):3487–95.PubMedCrossRef
6.
Evans DB, Varadhachary GR, Crane CH, et al. Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26(21):3496–502.PubMedCrossRef
7.
Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013;310(14):1473–81.PubMedCrossRef
8.
Pancreatic adenocarcinoma. Version 2.2104. NCCN Clinical Practice Guideline in Oncology (NCCN Guidelines) 2014.
9.
Bhatti I, Peacock O, Awan AK, Semeraro D, Larvin M, Hall RI. Lymph node ratio versus number of affected lymph nodes as predictors of survival for resected pancreatic adenocarcinoma. World J Surg. 2010;34(4):768–75.PubMedCrossRef
10.
La Torre M, Cavallini M, Ramacciato G, et al. Role of the lymph node ratio in pancreatic ductal adenocarcinoma. Impact on patient stratification and prognosis. J Surg Oncol. 2011;104(6):629–33.PubMedCrossRef
11.
Murakami Y, Uemura K, Sudo T, et al. Number of metastatic lymph nodes, but not lymph node ratio, is an independent prognostic factor after resection of pancreatic carcinoma. J Am Coll Surg. Aug 2010;211(2):196–204.PubMedCrossRef
12.
Pawlik TM, Gleisner AL, Cameron JL, et al. Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery. 2007;141(5):610–8.PubMedCrossRef
13.
Roland CL, Yang AD, Katz MHG, et al. Neoadjuvant therapy is associated with a reduced lymph node ratio in patients with potentially resectable pancreatic cancer. Ann Surg Oncol. 2015;22(4):1168–75.PubMedCrossRef
14.
Slidell MB, Chang DC, Cameron JL, et al. Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis. Ann Surg Oncol. 2008;15(1):165–74.PubMedCrossRef
15.
Hwang RF, Wang H, Lara A, et al. Development of an integrated biospecimen bank and multidisciplinary clinical database for pancreatic cancer. Ann Surg Oncol. 2008;15(5):1356–66.PubMedCrossRef
16.
Tzeng CW, Fleming JB, Lee JE, et al. Defined clinical classifications are associated with outcome of patients with anatomically resectable pancreatic adenocarcinoma treated with neoadjuvant therapy. Ann Surg Oncol. 2012;19(6):2045–53.PubMedCrossRef
17.
Yen TW, Abdalla EK, Pisters PW, Evans DB. Pancreaticoduodenectomy. Sandury: Jones and Bartlett; 2005.
18.
Katz MH, Wang H, Balachandran A, et al. Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer. J Gastrointest Surg. 2012;16(1):68–78; discussion 78–69.PubMedCrossRef
19.
Katz MH, Pisters PW, Evans DB, et al. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg. 2008;206(5):833–846; discussion 846–838.PubMedCrossRef
20.
Estrella JS, Rashid A, Fleming JB, et al. Post-therapy pathologic stage and survival in patients with pancreatic ductal adenocarcinoma treated with neoadjuvant chemoradiation. Cancer. 2012;118(1):268–77.PubMedCrossRef
21.
Pingpank JF, Hoffman JP, Ross EA, et al. Effect of preoperative chemoradiotherapy on surgical margin status of resected adenocarcinoma of the head of the pancreas. J Gastrointest Surg. 2001;5(2):121–30.PubMedCrossRef
22.
White RR, Hurwitz HI, Morse MA, et al. Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas. Ann Surg Oncol. 2001;8(10):758–65.PubMedCrossRef
23.
Ghaneh P, Neoptolemos JP. Conclusions from the European Study Group for Pancreatic Cancer adjuvant trial of chemoradiotherapy and chemotherapy for pancreatic cancer. Surg Oncol Clin North Am. 2004;13(4):567–87, vii–viii.
24.
Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004;350(12):1200–10.PubMedCrossRef
Metadata
Title
The Addition of Postoperative Chemotherapy is Associated with Improved Survival in Patients with Pancreatic Cancer Treated with Preoperative Therapy
Authors
Christina L. Roland, MD
Matthew H. G. Katz, MD
Ching-Wei D. Tzeng, MD
Heather Lin, PhD
Gauri R. Varadhachary, MD
Rachna Shroff, MD
Milind Javle, MD
David Fogelman, MD
Robert A. Wolff, MD
Jean N. Vauthey, MD
Christopher H. Crane, MD
Jeffrey E. Lee, MD
Jason B. Fleming, MD
Publication date
01-12-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue Special Issue 3/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4854-z

Other articles of this Special Issue 3/2015

Annals of Surgical Oncology 3/2015 Go to the issue

Gastrointestinal Oncology

Development and Validation of a Disease-Specific Instrument to Measure Diet-Targeted Quality of Life for Postoperative Patients with Esophagogastric Cancer

Gastrointestinal Oncology

Influence of Different Neoadjuvant Chemotherapy Regimens on Response, Prognosis, and Complication Rate in Patients with Esophagogastric Adenocarcinoma

Gastrointestinal Oncology

A Simple and Reliable Method for Intracorporeal Circular-Stapled Esophagojejunostomy Using a Hand-Sewn Over-and-Over Suture Technique in Laparoscopic Total Gastrectomy

Melanomas

How Often Do Patients with Localized Melanoma Attend Follow-Up at a Specialist Center?

Gastrointestinal Oncology

A Minimally Invasive Technique to Obtain Optimal Tumor Margins in Anatomically Confined Locations Using a Contoured Stapler

Translational Research and Biomarkers

Expressional STAT3/STAT5 Ratio is an Independent Prognostic Marker in Colon Carcinoma