Is adjuvant radiation plus chemotherapy for resectable pancreatic adenocarcinoma associated with improved survival? The Cleveland Clinic experience

Abstract

15528 Background: A large single-institution series of pts who recently underwent pancreaticoduodenectomy for resectable pancreatic cancer was analyzed to determine prognostic factors for overall survival (OS), including the impact of adjuvant radiation (XRT) and chemo (CT). Methods: Medical records were reviewed for 179 consecutive pts tx'd at The Cleveland Clinic w/ pancreaticoduodenectomy for resectable pancreatic adenoca. from 10/1999 to 12/2006. Clinical data was collected, Kaplan Meier method was used to estimate OS, and univariate/multivariate analysis was performed. Results: 179 pts with T1–3N0–1M0 pancreatic cancer met the above criteria. Median age at surgery was 67 (range 35–93) and median length of post-op hospital stay was 10 days. Peri-op mortality rate was 0.6%. 77% pts were R0 and 31% N0. Median OS for R0 pts = 20 mths [vs 16.3 mths for R1 (p=.86)]. Median OS for pts tx'd w/ XRT + CT was 28.1 mths [vs. 10.9 mths for pts receiving no adj. tx (p=.001)] (see table). In pts who relapse, the liver is the most common site (>50%). On univariate analysis, poor prognostic factors for OS were: poorly diff. histology (p=.002), >1 positive lymph node (p=.02), elevated AlkPhos (p=.01), elevated total bilirubin (p=.02), elevated AST (p=.05), age at dx >70 (p=.05), and high T-stage (p=.06). On multivariate analysis, poorly diff. histology, age >70, and elevated LFT's (AlkPhos or bilirubin or AST) were independent predictors of OS. Conclusions: In the 21st century, curative-intent surgery for pancreatic cancer at large academic institutions can have very low mortality rates. Pts who receive adj. XRT + CT appear to live longer than pts who receive no adjuvant therapy in this retrospective analysis. Pathology findings are valuable prognostic markers in resected pancreatic cancer. Few studies have examined the prognostic value of pre-op LFT's; our analysis indicates they may have predictive value - this should be confirmed in other series. Adj. Tx % pts Median OS (mths) XRT/CT + CT 22 23.3 XRT/CT 40 28.1 CT only 12 >28 No adj. tx 26 10.9 All pts - 19.6 No significant financial relationships to disclose.