• Giampaolo Perri, Laura Prakash, Huamin Wang, Priya Bhosale, Gauri R Varadhachary, Robert Wolff, David Fogelman, Michael Overman, Shubham Pant, Milind Javle, Eugene Koay, Joseph Herman, Michael Kim, Naruhiko Ikoma, Ching-Wei Tzeng, Jeffrey E Lee, and KatzMatthew H GMHGDepartment of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX..
• Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
• Ann. Surg. 2021 Apr 1; 273 (4): 806813806-813.

ObjectiveWe sought to identify potential radiologic and serologic markers of pancreatic tumor response to therapy, using pathologic major response (pMR) as the objective endpoint.BackgroundWe previously demonstrated that a pMR to preoperative therapy, defined as detection of <5% viable cancer cells in the surgical specimen on histopathological analysis, is an important prognostic factor for patients with pancreatic ductal adenocarcinoma (PDAC).MethodsPretreatment and posttreatment computed tomography scans of consecutive patients who received preoperative chemotherapy and/or (chemo)radiation before pancreatectomy for PDAC between January 2010 and December 2018 were rereviewed. Response per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, other radiographic changes in tumor size and anatomic extent, and posttreatment CA 19-9 levels were compared between patients who did and did not have a pMR on final histopathologic analysis of their surgical specimens.ResultsA total of 290 patients with localized PDAC underwent pancreatectomy between 2010 and 2018 after receiving preoperative chemotherapy (n = 36; 12%), (chemo)radiation (n = 87; 30%), or both (n = 167; 58%). Among them, 28 (10%) experienced pMR, including 9 (3.1%) who experienced pathologic complete response. On multivariable logistic regression, low posttreatment CA 19-9 level, RECIST partial response, and reduction in tumor volume were confirmed to be independently associated with pMR (P < 0.01).ConclusionsWe identified serologic and radiographic indicators of pMR that could help inform the delivery of preoperative therapy to patients with PDAC.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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