Histopathological tumour viability after neoadjuvant chemotherapy influences survival in resected pancreatic cancer: analysis of early outcome data

Phil Townend, Phil R. de Reuver, Terence C. Chua, Anubhav Mittal, Stephen J. Clark, Nick Pavlakis, Anthony J. Gill, Jaswinder S. Samra

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Neoadjuvant therapy is increasingly recognized as an effective strategy prior to pancreatoduodenectomy. We investigate the role of neoadjuvant chemotherapy (NAC) followed by surgery and the predictive role of viable residual tumour cells histopathologically on outcomes. Methods: The study population comprised of 195 consecutive patients with pancreatic adenocarcinoma who were treated with either NAC or a surgery-first (SF) strategy. Histopathological viable tumour cells were examined in the NAC patients and clinicopathological factors were correlated with overall survival. Results: Forty-two patients (22%) were treated with NAC and 153 patients (78%) underwent SF. NAC was associated with higher estimated blood loss during surgery (928mL versus 615mL; P=0.004), fewer (<15) excised lymph nodes (37% versus 17%; P=0.015) and lower rates of lymphovascular invasion (65% versus 45%; P=0.044) when compared with SF. Two-year survival of patients undergoing NAC was 63% and 51% in patients undergoing SF (P=0.048). The 2-year survival of patients who had >65% residual tumour cells was 45% and 90% in patients who had <65% residual tumour cells (P=0.022). Favourable responders (<65% viable tumour cells) were observed to have shorter operation time (<420min) (55% versus 13%; P=0.038), trend towards negative lymph node status (38% versus 10%; P=0.067) and greater lymph node harvest in node positive patients (≥4 positive lymph nodes) (77% versus 37%; P=0.045). Conclusion: The improved survival of patients undergoing NAC indicates effective management of micrometastatic disease and is an effective option requiring further investigation. Histopathological viable tumour cells after NAC was a surrogate marker for survival.

LanguageEnglish
PagesE167-E172
Number of pages6
JournalANZ Journal of Surgery
Volume88
Issue number3
DOIs
Publication statusPublished - Mar 2018

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Pancreatic Neoplasms
Drug Therapy
Survival
Residual Neoplasm
Neoplasms
Lymph Nodes
Neoadjuvant Therapy
Pancreaticoduodenectomy
Disease Management
Adenocarcinoma
Biomarkers
Population

Keywords

  • Lymph node
  • Metastasis
  • Neoadjuvant chemotherapy
  • Pancreatic cancer
  • Pancreatoduodenectomy
  • Prognostic factors

Cite this

Townend, Phil ; de Reuver, Phil R. ; Chua, Terence C. ; Mittal, Anubhav ; Clark, Stephen J. ; Pavlakis, Nick ; Gill, Anthony J. ; Samra, Jaswinder S. / Histopathological tumour viability after neoadjuvant chemotherapy influences survival in resected pancreatic cancer : analysis of early outcome data. In: ANZ Journal of Surgery. 2018 ; Vol. 88, No. 3. pp. E167-E172.
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title = "Histopathological tumour viability after neoadjuvant chemotherapy influences survival in resected pancreatic cancer: analysis of early outcome data",
abstract = "Background: Neoadjuvant therapy is increasingly recognized as an effective strategy prior to pancreatoduodenectomy. We investigate the role of neoadjuvant chemotherapy (NAC) followed by surgery and the predictive role of viable residual tumour cells histopathologically on outcomes. Methods: The study population comprised of 195 consecutive patients with pancreatic adenocarcinoma who were treated with either NAC or a surgery-first (SF) strategy. Histopathological viable tumour cells were examined in the NAC patients and clinicopathological factors were correlated with overall survival. Results: Forty-two patients (22{\%}) were treated with NAC and 153 patients (78{\%}) underwent SF. NAC was associated with higher estimated blood loss during surgery (928mL versus 615mL; P=0.004), fewer (<15) excised lymph nodes (37{\%} versus 17{\%}; P=0.015) and lower rates of lymphovascular invasion (65{\%} versus 45{\%}; P=0.044) when compared with SF. Two-year survival of patients undergoing NAC was 63{\%} and 51{\%} in patients undergoing SF (P=0.048). The 2-year survival of patients who had >65{\%} residual tumour cells was 45{\%} and 90{\%} in patients who had <65{\%} residual tumour cells (P=0.022). Favourable responders (<65{\%} viable tumour cells) were observed to have shorter operation time (<420min) (55{\%} versus 13{\%}; P=0.038), trend towards negative lymph node status (38{\%} versus 10{\%}; P=0.067) and greater lymph node harvest in node positive patients (≥4 positive lymph nodes) (77{\%} versus 37{\%}; P=0.045). Conclusion: The improved survival of patients undergoing NAC indicates effective management of micrometastatic disease and is an effective option requiring further investigation. Histopathological viable tumour cells after NAC was a surrogate marker for survival.",
keywords = "Lymph node, Metastasis, Neoadjuvant chemotherapy, Pancreatic cancer, Pancreatoduodenectomy, Prognostic factors",
author = "Phil Townend and {de Reuver}, {Phil R.} and Chua, {Terence C.} and Anubhav Mittal and Clark, {Stephen J.} and Nick Pavlakis and Gill, {Anthony J.} and Samra, {Jaswinder S.}",
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Townend, P, de Reuver, PR, Chua, TC, Mittal, A, Clark, SJ, Pavlakis, N, Gill, AJ & Samra, JS 2018, 'Histopathological tumour viability after neoadjuvant chemotherapy influences survival in resected pancreatic cancer: analysis of early outcome data', ANZ Journal of Surgery, vol. 88, no. 3, pp. E167-E172. https://doi.org/10.1111/ans.13897

Histopathological tumour viability after neoadjuvant chemotherapy influences survival in resected pancreatic cancer : analysis of early outcome data. / Townend, Phil; de Reuver, Phil R.; Chua, Terence C.; Mittal, Anubhav; Clark, Stephen J.; Pavlakis, Nick; Gill, Anthony J.; Samra, Jaswinder S.

In: ANZ Journal of Surgery, Vol. 88, No. 3, 03.2018, p. E167-E172.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Histopathological tumour viability after neoadjuvant chemotherapy influences survival in resected pancreatic cancer

T2 - Australian and New Zealand Journal of Surgery

AU - Townend, Phil

AU - de Reuver, Phil R.

AU - Chua, Terence C.

AU - Mittal, Anubhav

AU - Clark, Stephen J.

AU - Pavlakis, Nick

AU - Gill, Anthony J.

AU - Samra, Jaswinder S.

PY - 2018/3

Y1 - 2018/3

N2 - Background: Neoadjuvant therapy is increasingly recognized as an effective strategy prior to pancreatoduodenectomy. We investigate the role of neoadjuvant chemotherapy (NAC) followed by surgery and the predictive role of viable residual tumour cells histopathologically on outcomes. Methods: The study population comprised of 195 consecutive patients with pancreatic adenocarcinoma who were treated with either NAC or a surgery-first (SF) strategy. Histopathological viable tumour cells were examined in the NAC patients and clinicopathological factors were correlated with overall survival. Results: Forty-two patients (22%) were treated with NAC and 153 patients (78%) underwent SF. NAC was associated with higher estimated blood loss during surgery (928mL versus 615mL; P=0.004), fewer (<15) excised lymph nodes (37% versus 17%; P=0.015) and lower rates of lymphovascular invasion (65% versus 45%; P=0.044) when compared with SF. Two-year survival of patients undergoing NAC was 63% and 51% in patients undergoing SF (P=0.048). The 2-year survival of patients who had >65% residual tumour cells was 45% and 90% in patients who had <65% residual tumour cells (P=0.022). Favourable responders (<65% viable tumour cells) were observed to have shorter operation time (<420min) (55% versus 13%; P=0.038), trend towards negative lymph node status (38% versus 10%; P=0.067) and greater lymph node harvest in node positive patients (≥4 positive lymph nodes) (77% versus 37%; P=0.045). Conclusion: The improved survival of patients undergoing NAC indicates effective management of micrometastatic disease and is an effective option requiring further investigation. Histopathological viable tumour cells after NAC was a surrogate marker for survival.

AB - Background: Neoadjuvant therapy is increasingly recognized as an effective strategy prior to pancreatoduodenectomy. We investigate the role of neoadjuvant chemotherapy (NAC) followed by surgery and the predictive role of viable residual tumour cells histopathologically on outcomes. Methods: The study population comprised of 195 consecutive patients with pancreatic adenocarcinoma who were treated with either NAC or a surgery-first (SF) strategy. Histopathological viable tumour cells were examined in the NAC patients and clinicopathological factors were correlated with overall survival. Results: Forty-two patients (22%) were treated with NAC and 153 patients (78%) underwent SF. NAC was associated with higher estimated blood loss during surgery (928mL versus 615mL; P=0.004), fewer (<15) excised lymph nodes (37% versus 17%; P=0.015) and lower rates of lymphovascular invasion (65% versus 45%; P=0.044) when compared with SF. Two-year survival of patients undergoing NAC was 63% and 51% in patients undergoing SF (P=0.048). The 2-year survival of patients who had >65% residual tumour cells was 45% and 90% in patients who had <65% residual tumour cells (P=0.022). Favourable responders (<65% viable tumour cells) were observed to have shorter operation time (<420min) (55% versus 13%; P=0.038), trend towards negative lymph node status (38% versus 10%; P=0.067) and greater lymph node harvest in node positive patients (≥4 positive lymph nodes) (77% versus 37%; P=0.045). Conclusion: The improved survival of patients undergoing NAC indicates effective management of micrometastatic disease and is an effective option requiring further investigation. Histopathological viable tumour cells after NAC was a surrogate marker for survival.

KW - Lymph node

KW - Metastasis

KW - Neoadjuvant chemotherapy

KW - Pancreatic cancer

KW - Pancreatoduodenectomy

KW - Prognostic factors

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