Factors Associated with Overall Survival in Pancreatic Cancer Treated with Neoadjuvant Therapy and Surgery

Abstract

Introduction: Median survival following surgical resection of pancreatic cancer (PC) has increased due to advances in chemotherapy, radiotherapy, and surgical technique. We examined clinical factors associated with overall survival (OS) in patients with PC who received neoadjuvant therapy and surgery. Method: We conducted a retrospective review of a prospectively maintained PC database at high-volume referral center. Patients with non-metastatic PC who received neoadjuvant therapy and underwent surgical resection between 2009 and 2019 were included. Demographic, clinical, and pathologic variables were examined with Cox proportional hazards models to identify prognostic factors on OS. Results: Neoadjuvant therapy and surgery was completed in 460 consecutive patients; 227 (49.4%) patients were female. The median age was 64 (IQR[58, 71]) years. Median OS was 40.2 (IQR[23.4, 87.3]) months. On bivariate analysis, elevated CA19-9 prior to surgery (HR 1.8 [1.4,2.3]), vein resection (HR 1.6 [1.2, 2.1]), lymphovascular invasion (HR 1.5 [1.1, 2.0]), positive superior mesenteric artery margin (HR 1.8 [1.2, 2.7]) and higher nodal stage were associated with worse OS. On multivariate analysis, shorter OS was associated with increased CA19-9 (HR 1.6 [1.2,2.2]), higher nodal stage (HR 1.5 [1.0, 2.1] for N1; HR 1.9 [1.2, 3.0] for N2), and liver as the first site of disease recurrence. Preoperative clinical stage was not a significance predictor of OS. Conclusions: We report OS outcomes from one of the largest cohorts of resected PC in the era of neoadjuvant therapy. Preoperative CA19-9 after neoadjuvant therapy was associated with OS, emphasizing the impact of treatment response on OS.