Significance of Pathologic Response to Preoperative Therapy in Pancreatic Cancer: The Future Ain’t What It Used To Be

Excerpt

Over the past 10 years, our ability to predict the future of an individual patient with cancer has moved beyond T, N, and M. Although American Joint Committee on Cancer (AJCC) stage continues to be the bedrock of determining prognosis, a number of other factors have been identified that can stratify recurrence and survival outcome for a given patient within each stage category. Radiographic response, pathologic response, and a variety of molecular markers have been identified as important predictors of outcome. Complete pathologic response (cPR) to preoperative therapy has been found to be an independent predictor of survival in breast and rectal cancer, and the incorporation of this response into the AJCC staging system has been recommended for breast cancer patients who receive neoadjuvant therapy. 1,2 In a study from Memorial Sloan-Kettering Cancer Center of 200 patients undergoing resection for rectal cancer after preoperative chemoradiation, cPR trumped pretreatment stage in predicting outcome. 1 Importantly, in this study all patients underwent pretreatment and preoperative endorectal ultrasound (ERUS), and the pretreatment ERUS stage groupings were similar between patients who experienced cPR and those who did not. cPR was observed in 30% of patients (56% of patients with uT3N1 experienced cPR), and the survival in the cPR group was 90% at 5 years, compared with 68% in those without response. So, as the famous New York soothsayer Yogi Bera once said, “the future ain’t what it used to be.” …