V47: Predictors of Recurrence and Survival in Resectable Distal Pancreatic Cancer

Wednesday, March 2, 2022

6:16 PM – 6:19 PM CST

Location: Zoom Meeting

Virtual Poster Presenter(s)

Amer H. Zureikat, MD

Associate Professor of Surgery, Chief Division of Surgical Oncology
University of Pittsburgh
Pittsburgh, Pennsylvania, United States

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Participants should be aware of the following financial/non-financial relationships:

Amer H. Zureikat, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Introduction: Neoadjuvant chemotherapy (NAC) is gaining increasing popularity over surgery-first (SF) approach in treating resectable and borderline resectable pancreatic ductal adenocarcinoma (PDAC), even in distal tumors. This study aims to examine the impact of NAC in distal PDAC on patterns of recurrence and identify predictors of survival.

Methods:

A single institute PDAC database was surveyed for patients with distal PDAC that underwent surgical resection between 2010 & 2019. The cohort was stratified based on receipt of NAC. Distal pancreatectomy with celiac axis resection was excluded. Optimal CA19-9 response was defined as normalization and >50% reduction. Kaplan-Meier (KM) curves and multivariate-adjusted Cox models were used to evaluate predictors of survival; progression-free and overall survival (OS) were calculated from diagnosis.

Results: One hundred and twenty-seven (n=127) patients were included in this study (NAC: 65, SF: 62). No difference was seen between the two cohorts regarding site of first recurrence (p=0.716), incidence of local progression (p=0.836), or progression free survival (p=0.890). On KM survival estimates examining OS, NAC trended towards association with improvement in survival although did not reach statistical significance (45.1 vs. 25.6, p=0.059). On multivariate-adjusted Cox model, age (HR: 1.02 [1.00, 1.05), p=0.049), lymph node ratio >0.2 (HR: 3.95 [1.93, 8.10), p< 0.001), and presence of perineural invasion (HR: 3.06 [1.08, 8.68), p=0.035) were all associated with worse overall survival, while total duration of therapy (neoadjuvant + adjuvant) 3-6 (HR: 0.43 [0.20, 0.94), p=0.034) and ≥6 months (HR: 0.25 [0.10, 0.65), p=0.004) were protective.

Conclusions: No difference in patterns of recurrence was observed in distal PDAC following resection when comparing NAC vs. SF cohorts. However, total duration of therapy of 3-6 months and ≥6 months were identified as predictors of improved survival.

Learning Objectives:

Identify the difference in recurrence patterns between surgery first cohort and neoadjuvant therapy followed by surgery cohort in distal pancreatic ductal adenocarcinoma.
Identify predictors of survival in resectable distal pancreatic ductal adenocarcinoma.
Define impact of neoadjuvant therapy and total duration of therapy on survival in distal pancreatic ductal adenocarcinoma.