Tumor Size Differences Between Preoperative Endoscopic Ultrasound and Postoperative Pathology for Neoadjuvant-Treated Pancreatic Ductal Adenocarcinoma Predict Patient Outcome

Rohit Das, Kevin McGrath, Natalie Seiser, Katelyn Smith, Shikhar Uttam, Randall E. Brand, Kenneth E. Fasanella, Asif Khalid, Jennifer S. Chennat, Savreet Sarkaria, Harkirat Singh, Adam Slivka, Herbert J. Zeh, Amer H. Zureikat, Melissa E. Hogg, Kenneth K. Lee, Alessandro Paniccia, Melanie C. Ongchin, James F. Pingpank, Brian A. BooneAnil K. Dasyam, Nathan Bahary, Vikram C. Gorantla, John C. Rhee, Roby Thomas, Susannah Ellsworth, Michael S. Landau, N. Paul Ohori, Patrick Henn, Susan Shyu, Brian K. Theisen, Aatur D. Singhi

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background & Aims: The assessment of therapeutic response after neoadjuvant treatment and pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) has been an ongoing challenge. Several limitations have been encountered when employing current grading systems for residual tumor. Considering endoscopic ultrasound (EUS) represents a sensitive imaging technique for PDAC, differences in tumor size between preoperative EUS and postoperative pathology after neoadjuvant therapy were hypothesized to represent an improved marker of treatment response. Methods: For 340 treatment-naïve and 365 neoadjuvant-treated PDACs, EUS and pathologic findings were analyzed and correlated with patient overall survival (OS). A separate group of 200 neoadjuvant-treated PDACs served as a validation cohort for further analysis. Results: Among treatment-naïve PDACs, there was a moderate concordance between EUS imaging and postoperative pathology for tumor size (r = 0.726, P < .001) and AJCC 8th edition T-stage (r = 0.586, P < .001). In the setting of neoadjuvant therapy, a decrease in T-stage correlated with improved 3-year OS rates (50% vs 31%, P < .001). Through recursive partitioning, a cutoff of ≥47% tumor size reduction was also found to be associated with improved OS (67% vs 32%, P < .001). Improved OS using a ≥47% threshold was validated using a separate cohort of neoadjuvant-treated PDACs (72% vs 36%, P < .001). By multivariate analysis, a reduction in tumor size by ≥47% was an independent prognostic factor for improved OS (P = .007). Conclusions: The difference in tumor size between preoperative EUS imaging and postoperative pathology among neoadjuvant-treated PDAC patients is an important prognostic indicator and may guide subsequent chemotherapeutic management.

Original languageEnglish (US)
Pages (from-to)886-897
Number of pages12
JournalClinical Gastroenterology and Hepatology
Volume20
Issue number4
DOIs
StatePublished - Apr 2022

Keywords

  • Cancer
  • Diagnosis
  • Pancreas
  • Prognosis
  • Size
  • Stage
  • Survival
  • Treatment

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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