Histologic grading of the extent of residual carcinoma following neoadjuvant chemoradiation in pancreatic ductal adenocarcinoma

Abstract

Background Several grading schemes for the extent of residual tumor in post-treatment pancreaticoduodenectomy (PD) specimens have been proposed. However, the prognostic significance of these grading schemes is unknown. Methods Histopathologic slides of 223 cases who received neoadjuvant chemoradiation and PD were reviewed. The extent of residual tumor was graded using both the College of American Pathologists (CAP) and the Evans grading systems. The grading results were correlated with clinicopathological parameters and survival. Results Among the 223 patients, 6 patients (2.7%) showed pathologic complete response (pCR, CAP Grade 0 or Evans grade IV), 36 cases (16.1%) with minimal residual tumor (CAP Grade 1 or Evans grade III), 124 cases (55.6%) with moderate response (CAP Grade 2 or Evans grade IIb) and 57 cases (25.6%) with poor response (CAP grade 3, 18 with Evans Grade I and 39 with Evans Grade IIa response). Patients with pCR or minimal residual tumor (response group 1) had better survivals than those with moderate and poor response (response group 2). Response group 1 patients had lower post-therapy tumor and AJCC stages, lower rates of lymph node metastasis, positive resection margin, and recurrence/metastasis. Grading the extent of residual tumor is an independent prognostic factor for OS in multivariate analysis. Conclusions pCR or minimal residual tumor in post-treatment PD specimens correlate with better survival in patients with PDAC who received neoadjuvant therapy and PD. Histologic grading of the extent of residual tumor in PD specimen is an important prognostic factor in patients with PDAC who received neoadjuvant therapies.

Transport properties of pancreatic cancer describe gemcitabine delivery and response

“…We observed distinct CT signatures in patients who had complete pathological responses compared with those with poor responses to therapy ( Figure 4A), and the normalized CT-derived parameter AUC directly correlated with pathological response (Spearman rank-order correlation, -0.30; 95% CI, -0.51 to -0.05; P = 0.02; Figure 4B). As previously observed by our group (18,21), patients with better grades of pathological responses (i.e., fewer viable cells after therapy) had improved prognosis, and as response correlated directly with normalized AUC, patients with higher normalized AUC values also had improved prognosis (Supplemental Table 8). Multivariate analysis of the 80 patients who underwent resection confirmed that normalized AUC was an independent predictor of overall survival (Table 2).…”

Neoadjuvant chemotherapy in borderline resectable pancreatic cancer: A case report

“…In malignancies such as rectal, esophageal and breast cancer, pCR has been associated with improved disease-free survival and OS (73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83). In PAC, a number of studies reported pathologic outcomes following neoadjuvant chemotherapy with or without fractionated radiotherapy or stereotactic body radiotherapy, and the pCR rate ranges between 2.4 and 32.0% (41,(84)(85)(86)(87)(88)(89)(90)(91)(92)(93)(94). Two of these studies reported a significantly improved OS for patients who achieved pCR compared with that of patients who did not (88,89), although this finding was not confirmed by a different study (90).…”

“…In PAC, a number of studies reported pathologic outcomes following neoadjuvant chemotherapy with or without fractionated radiotherapy or stereotactic body radiotherapy, and the pCR rate ranges between 2.4 and 32.0% (41,(84)(85)(86)(87)(88)(89)(90)(91)(92)(93)(94). Two of these studies reported a significantly improved OS for patients who achieved pCR compared with that of patients who did not (88,89), although this finding was not confirmed by a different study (90). In the aforementioned studies involving neoadjuvant FOLFIRINOX, no specific survival data were reported in patients who achieved pCR.…”

A Pilot Study of Diffusion-Weighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer

“…Our primary endpoint was pathologic response according to the grading system developed by Evans et al [19]. This system has been utilized in prior studies and is shown to correlate with patient outcome [19,26]. Larger studies will be required to determine if dMRI is useful as a prognostic marker for early treatment response stratification of patients with pancreatic cancer.…”