Type of neoadjuvant treatment strategy is associated with differential pathologic responses in pancreatic ductal adenocarcinoma

Am J Surg. 2024 Jun:232:9-14. doi: 10.1016/j.amjsurg.2023.10.053. Epub 2023 Nov 8.

Abstract

Background: Tumor fibrosis after neoadjuvant treatment (NAT) for pancreatic ductal adenocarcinoma (PDAC) correlates with treatment response. Herein we assessed how different NAT strategies influence pathologic responses and survival.

Methods: Patients with surgically resected PDAC who received NAT (1991-2020) were included. Descriptive statistics compared outcomes amongst fibrosis groups (none, minor <50 ​%, partial 51%-94 ​%, major ≥95 ​%) and NAT (chemotherapy alone, chemoradiation, or chemotherapy ​+ ​chemoradiation (total neoadjuvant therapy, TNT)).

Results: Patients with major fibrosis most often received TNT (65.8 ​%, p ​< ​0.001). Major fibrosis was associated with the greatest rate of downstaging (77.8 ​%, p ​< ​0.001), highest R0 margin rate (100 ​%, p ​< ​0.01), and lowest mean positive lymph node ratio (0.80, p ​< ​0.01). Amongst complete responders, 11/14 (78.6 ​%) received TNT. Median overall (66.3 months, p ​= ​0.003) and disease-free (54.7months, p ​= ​0.05) survival were highest with major fibrosis.

Conclusions: Major fibrosis and complete pathologic responses after NAT are most frequent with a TNT strategy and are associated with improved outcomes.

Keywords: Fibrosis; Neoadjuvant; Pancreatic cancer.

MeSH terms

  • Aged
  • Carcinoma, Pancreatic Ductal* / mortality
  • Carcinoma, Pancreatic Ductal* / pathology
  • Carcinoma, Pancreatic Ductal* / therapy
  • Female
  • Fibrosis
  • Humans
  • Male
  • Middle Aged
  • Neoadjuvant Therapy*
  • Neoplasm Staging
  • Pancreatectomy
  • Pancreatic Neoplasms* / mortality
  • Pancreatic Neoplasms* / pathology
  • Pancreatic Neoplasms* / therapy
  • Retrospective Studies
  • Treatment Outcome