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Survival Trends for Resectable Pancreatic Cancer Using a Multidisciplinary Conference: the Impact of Post-operative Chemotherapy

  • Aslam R. Syed
  • Neil M. Carleton
  • Zachary Horne
  • Annika Dhawan
  • Gurneet Bedi
  • Gursimran Kochhar
  • Suzanne Morrissey
  • Harry Williams
  • Donald Atkinson
  • Suzanne Schiffman
  • Dulabh Monga
  • Anthony Lupetin
  • Alexander Kirichenko
  • Marcia Mitre
  • Manish Dhawan
  • Abhijit Kulkarni
  • Shyam ThakkarEmail author
Original Research
  • 3 Downloads

Abstract

Purpose

Despite advances in various treatment modalities, surgical resection for pancreatic ductal adenocarcinoma (PDA) remains the only curative treatment. Data remains limited regarding survival rates for resectable PDA when managed by a multidisciplinary pancreas conference (MDPC). The aim of this study is to assess survival rates, identify significant predictors of mortality, and assess the benefits of adjuvant chemotherapy for resectable PDA following presentation at a MDPC.

Methods

All patients presented from April 2013 to August 2016 with resectable PDA were discussed at a MDPC at a tertiary care center and were followed prospectively until November 2017. Survival analysis was performed using Kaplan-Meier for age, tumor size, tumor differentiation, T-stage, lymph node status, and completion of adjuvant chemotherapy cycles. Independent predictors of survival were determined using multivariate Cox regression modeling.

Results

After MDPC consensus and exclusions, total of 64 patients underwent successful surgery. Amongst this cohort, 1-, 2-, and 3-year survival was 78.13%, 46.30%, and 27.27%, respectively. A total of 37 patients (58%) initiated and 16 patients (25%) finished chemotherapy following surgery. Log-rank analysis revealed that tumor size, age, surgical margins, lymph node status, and number of adjuvant chemotherapy cycles received significantly influenced post-operative survival. Tumor size (p < 0.001), lymph node status (p = 0.035), and number of adjuvant chemotherapy cycles (p = 0.041) remained significant after multivariate Cox regression model.

Conclusions

Our results suggest that patients with PDA with tumor size > 50 mm and/or lymph node involvement have poor outcomes despite being surgically resectable. Successful completion of adjuvant chemotherapy has better survival outcomes as compared with incomplete or no adjuvant chemotherapy. The role of alternative management such as down-staging with neoadjuvant therapy should be considered.

Keywords

Resectable pancreatic cancer Multidisciplinary pancreatic cancer conference Survival outcomes Adjuvant chemotherapy Neoadjuvant therapy 

Notes

Acknowledgments

NMC is supported by the National Institute of General Medical Sciences of the National Institutes of Health (USA) under award number T32GM008208.

Specific Author Contributions

Conception and design: ARS, GK, ST

Acquisition of data: ARS, AD, SM, HW, DA, SS, DM, AL, AK, MM, MD, AK, ST

Analysis and interpretation of data: ARS, NMC, ZH, AD, ST

Drafting the manuscript: ARS, NMC, GB, ST

Final approval of the version to be published: ARS, NMC, ZH, AD, GB, GK, SM, HW, DA, SS, DM, AL, AK, MM, MD, AK, ST. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Disclaimer

The content reported here is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Aslam R. Syed
    • 1
  • Neil M. Carleton
    • 1
  • Zachary Horne
    • 2
  • Annika Dhawan
    • 1
  • Gurneet Bedi
    • 1
  • Gursimran Kochhar
    • 1
  • Suzanne Morrissey
    • 1
  • Harry Williams
    • 3
  • Donald Atkinson
    • 3
  • Suzanne Schiffman
    • 3
  • Dulabh Monga
    • 4
  • Anthony Lupetin
    • 5
  • Alexander Kirichenko
    • 2
  • Marcia Mitre
    • 1
  • Manish Dhawan
    • 1
  • Abhijit Kulkarni
    • 1
  • Shyam Thakkar
    • 1
    Email author
  1. 1.Division of GastroenterologyAllegheny Health NetworkPittsburghUSA
  2. 2.Department of Radiation OncologyAllegheny Health NetworkPittsburghUSA
  3. 3.Department of SurgeryAllegheny Health NetworkPittsburghUSA
  4. 4.Department of Hematology/OncologyAllegheny Health NetworkPittsburghUSA
  5. 5.Department of RadiologyAllegheny Health NetworkPittsburghUSA

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