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

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

doi:10.1245/s10434-015-4854-z

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

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

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43 Scopus citations

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.

Original language	English (US)
Pages (from-to)	1221-1228
Number of pages	8
Journal	Annals of surgical oncology
Volume	22
DOIs	https://doi.org/10.1245/s10434-015-4854-z
State	Published - Dec 1 2015

ASJC Scopus subject areas

Surgery
Oncology

MD Anderson CCSG core facilities

Biostatistics Resource Group

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10.1245/s10434-015-4854-z

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Roland, C. L., Katz, M. H. G., Tzeng, C. W. D., Lin, H., Varadhachary, G. R., Shroff, R., Javle, M., Fogelman, D., Wolff, R. A., Vauthey, J. N., Crane, C. H., Lee, J. E., & Fleming, J. B. (2015). The Addition of Postoperative Chemotherapy is Associated with Improved Survival in Patients with Pancreatic Cancer Treated with Preoperative Therapy. Annals of surgical oncology, 22, 1221-1228. https://doi.org/10.1245/s10434-015-4854-z

Roland, CL , Katz, MHG , Tzeng, CWD , Lin, H, Varadhachary, GR, Shroff, R, Javle, M, Fogelman, D, Wolff, RA , Vauthey, JN, Crane, CH, Lee, JE & Fleming, JB 2015, 'The Addition of Postoperative Chemotherapy is Associated with Improved Survival in Patients with Pancreatic Cancer Treated with Preoperative Therapy', Annals of surgical oncology, vol. 22, pp. 1221-1228. https://doi.org/10.1245/s10434-015-4854-z

@article{3d61c8008a744ac2833b78f2dbc72064,

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

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.",

author = "Roland, {Christina L.} and Katz, {Matthew H.G.} and Tzeng, {Ching Wei D.} and Heather Lin and Varadhachary, {Gauri R.} and Rachna Shroff and Milind Javle and David Fogelman and Wolff, {Robert A.} and Vauthey, {Jean N.} and Crane, {Christopher H.} and Lee, {Jeffrey E.} and Fleming, {Jason B.}",

note = "Funding Information: This research has been supported by the Khalifa Bin Zayed Al Nahyan Foundation and the various donor Pancreatic Cancer Research Funds at the University of Texas MD Anderson Cancer Center, the Ruth L. Kirschstein National Research Service Award NIH T32 CA009599, and the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30CA016672. We thank Mano Sundar for her management of our departmental pancreatic cancer database. Publisher Copyright: {\textcopyright} 2015, Society of Surgical Oncology.",

year = "2015",

month = dec,

day = "1",

doi = "10.1245/s10434-015-4854-z",

language = "English (US)",

volume = "22",

pages = "1221--1228",

journal = "Annals of surgical oncology",

issn = "1068-9265",

publisher = "Springer New York",

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TY - JOUR

T1 - The Addition of Postoperative Chemotherapy is Associated with Improved Survival in Patients with Pancreatic Cancer Treated with Preoperative Therapy

AU - Roland, Christina L.

AU - Katz, Matthew H.G.

AU - Tzeng, Ching Wei D.

AU - Lin, Heather

AU - Varadhachary, Gauri R.

AU - Shroff, Rachna

AU - Javle, Milind

AU - Fogelman, David

AU - Wolff, Robert A.

AU - Vauthey, Jean N.

AU - Crane, Christopher H.

AU - Lee, Jeffrey E.

AU - Fleming, Jason B.

N1 - Funding Information: This research has been supported by the Khalifa Bin Zayed Al Nahyan Foundation and the various donor Pancreatic Cancer Research Funds at the University of Texas MD Anderson Cancer Center, the Ruth L. Kirschstein National Research Service Award NIH T32 CA009599, and the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30CA016672. We thank Mano Sundar for her management of our departmental pancreatic cancer database. Publisher Copyright: © 2015, Society of Surgical Oncology.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - 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.

AB - 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.

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DO - 10.1245/s10434-015-4854-z

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AN - SCOPUS:84952871260

SN - 1068-9265

VL - 22

SP - 1221

EP - 1228

JO - Annals of surgical oncology

JF - Annals of surgical oncology

ER -

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

Abstract

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MD Anderson CCSG core facilities

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