Lymph node metrics following neoadjuvant therapy to refine patient selection for adjuvant chemotherapy in resected pancreatic cancer: A multi-institutional analysis.
Haleh Amirian, Erin Dickey, Ifeanyichukwu Ogobuiro, Edmond W Box, Ankit Shah, Mary P Martos, Manan Patel, Gregory C Wilson, Rebecca A Snyder, Alexander A Parikh, Chet Hammill, Hong J Kim, Daniel Abbott, Shishir K Maithel, Syed Nabeel Zafar, Michael T LeCompte, David A Kooby, Syed A Ahmad, Nipun B Merchant, Caitlin A Hester, Jashodeep Datta
{"title":"Lymph node metrics following neoadjuvant therapy to refine patient selection for adjuvant chemotherapy in resected pancreatic cancer: A multi-institutional analysis.","authors":"Haleh Amirian, Erin Dickey, Ifeanyichukwu Ogobuiro, Edmond W Box, Ankit Shah, Mary P Martos, Manan Patel, Gregory C Wilson, Rebecca A Snyder, Alexander A Parikh, Chet Hammill, Hong J Kim, Daniel Abbott, Shishir K Maithel, Syed Nabeel Zafar, Michael T LeCompte, David A Kooby, Syed A Ahmad, Nipun B Merchant, Caitlin A Hester, Jashodeep Datta","doi":"10.1002/jso.27798","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In patients with localized pancreatic ductal adenocarcinoma (PDAC) undergoing neoadjuvant therapy (NAT) and resection, selection of adjuvant chemotherapy (AC) is typically guided by high-risk features on histopathologic examination. We evaluated the interaction between post-NAT lymph node metrics and AC receipt on survival.</p><p><strong>Methods: </strong>Patients who received NAT followed by pancreatectomy (2010-2020) at seven centers were reviewed. Overall survival (OS) in patients receiving AC or not was stratified by lymph node positivity (LNP) or lymph node ratio (LNR) dichotomized at 0.1. Cox models evaluated the independent association between these nodal metrics, AC receipt, and OS.</p><p><strong>Results: </strong>Of 464 patients undergoing NAT and resection, 264 (57%) received AC. Patients selected for AC were younger (median 63 vs. 67 years; p < 0.001), received shorter duration of NAT (2.8 vs. 3.2 months; p = 0.01), had fewer postoperative complications (Clavien-Dindo grade > 3: 1.2% vs. 11.7%; p < 0.001), and lower rates of pathologic complete response (4% vs. 11%; p = 0.01). The median number of nodes evaluated was similar between cohorts (n = 20 in both; p = 0.9). Post-NAT LNP rates were not different, and median LNR was 0.1, in AC and non-AC cohorts. Both LNP (hazard ratio [HR]: 2.1, p < 0.001) and LNR (0 < LNR ≤ 0.1: HR: 1.98, p = 0.002; LNR > 0.1: HR 2.46, p < 0.001) were independently associated with OS on Cox modeling, although receipt of AC was not associated with improved OS (median 30.6 vs. 29.4 months; p = 0.2). In patients with LNR > 0.1, receipt of AC was associated with significantly longer OS compared to non-AC (24 vs. 20 months, respectively; p = 0.04).</p><p><strong>Conclusions: </strong>LNR following NAT, not simply nodal positivity, may be useful to refine selection of AC in resected PDAC.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/jso.27798","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: In patients with localized pancreatic ductal adenocarcinoma (PDAC) undergoing neoadjuvant therapy (NAT) and resection, selection of adjuvant chemotherapy (AC) is typically guided by high-risk features on histopathologic examination. We evaluated the interaction between post-NAT lymph node metrics and AC receipt on survival.
Methods: Patients who received NAT followed by pancreatectomy (2010-2020) at seven centers were reviewed. Overall survival (OS) in patients receiving AC or not was stratified by lymph node positivity (LNP) or lymph node ratio (LNR) dichotomized at 0.1. Cox models evaluated the independent association between these nodal metrics, AC receipt, and OS.
Results: Of 464 patients undergoing NAT and resection, 264 (57%) received AC. Patients selected for AC were younger (median 63 vs. 67 years; p < 0.001), received shorter duration of NAT (2.8 vs. 3.2 months; p = 0.01), had fewer postoperative complications (Clavien-Dindo grade > 3: 1.2% vs. 11.7%; p < 0.001), and lower rates of pathologic complete response (4% vs. 11%; p = 0.01). The median number of nodes evaluated was similar between cohorts (n = 20 in both; p = 0.9). Post-NAT LNP rates were not different, and median LNR was 0.1, in AC and non-AC cohorts. Both LNP (hazard ratio [HR]: 2.1, p < 0.001) and LNR (0 < LNR ≤ 0.1: HR: 1.98, p = 0.002; LNR > 0.1: HR 2.46, p < 0.001) were independently associated with OS on Cox modeling, although receipt of AC was not associated with improved OS (median 30.6 vs. 29.4 months; p = 0.2). In patients with LNR > 0.1, receipt of AC was associated with significantly longer OS compared to non-AC (24 vs. 20 months, respectively; p = 0.04).
Conclusions: LNR following NAT, not simply nodal positivity, may be useful to refine selection of AC in resected PDAC.
背景:在接受新辅助治疗(NAT)和切除术的局部胰腺导管腺癌(PDAC)患者中,辅助化疗(AC)的选择通常以组织病理学检查的高危特征为指导。我们评估了NAT后淋巴结指标和接受AC治疗对生存率的影响:我们回顾了在七个中心接受 NAT 后进行胰腺切除术的患者(2010-2020 年)。根据淋巴结阳性率(LNP)或淋巴结比率(LNR)对接受 AC 或未接受 AC 的患者的总生存率(OS)进行分层,淋巴结阳性率(LNP)或淋巴结比率(LNR)二分法为 0.1。Cox 模型评估了这些结节指标、接受 AC 和 OS 之间的独立关联:在接受 NAT 和切除术的 464 名患者中,264 人(57%)接受了 AC 治疗。被选中接受 AC 的患者更年轻(中位年龄为 63 岁 vs. 67 岁;P 3:1.2% vs. 11.7%;P 0.1:HR 2.46,P 0.1,与未接受 AC 的患者相比,接受 AC 的患者的 OS 明显更长(分别为 24 个月 vs. 20 个月;P = 0.04):结论:NAT后的LNR,而不仅仅是结节阳性,可能有助于完善PDAC切除术中AC的选择。
期刊介绍:
The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.