Prognosticators for Patients with Pancreatic Ductal Adenocarcinoma Who Received Neoadjuvant FOLFIRINOX or Gemcitabine/Nab-Paclitaxel Therapy and Pancreatectomy

SIMPLE SUMMARY: This study is to examine the clinical and pathologic characteristics and survival in patients who received neoadjuvant FOLFINOX or neoadjuvant gemcitabine/nab-paclitaxel (GemNP) followed by surgery with curative intent. Our study demonstrated that neoadjuvant FOLFIRINOX treatment is associated with younger age, higher rate of borderline resectable and locally advance disease, higher rate of radiation, lower ypN stage, and higher frequency of complete or near complete pathologic response compared to the GemNP group, but no significant differences in either disease-free survival or overall survival between these two treatment groups. We also demonstrated that multiple pathologic factors, including tumor response group, ypT, ypN, LVI, PNI, and resection margin status, were significant prognostic factors for survival in this group of PDAC patients. In addition, our findings suggest that the tumor size of 1.0 cm is a better cutoff for ypT2 in PDAC patients who received neoadjuvant therapy. ABSTRACT: Neoadjuvant FOLFIRINOX and gemcitabine/nab-paclitaxel (GemNP) therapies are increasingly used to treat patients with pancreatic ductal adenocarcinoma (PDAC). However, limited data are available on their clinicopathologic prognosticators. We examined the clinicopathologic factors and survival of 213 PDAC patients who received FOLFIRINOX with 71 patients who received GemNP. The FOLFIRINOX group was younger (p < 0.01) and had a higher rate of radiation (p = 0.049), higher rate of borderline resectable and locally advanced disease (p < 0.001), higher rate of Group 1 response (p = 0.045) and lower ypN stage (p = 0.03) than the GemNP group. Within FOLFIRINOX group, radiation was associated with decreased lymph node metastasis (p = 0.01) and lower ypN stage (p = 0.01). The tumor response group, ypT, ypN, LVI and PNI, correlated significantly with both DFS and OS (p < 0.05). Patients with the ypT0/T1a/T1b tumor had better DFS (p = 0.04) and OS (p = 0.03) than those with ypT1c tumor. In multivariate analysis, the tumor response group and ypN were independently prognostic factors for DFS and OS (p < 0.05). Our study demonstrated that the FOLFIRINOX group was younger and had a better pathologic response than the GemNP group and that the tumor response group, ypN, ypT, LVI and PNI, are significant prognostic factors for survival in these patients. Our results also suggest that the tumor size of 1.0 cm is a better cut off for ypT2. Our study highlights the importance of systemic pathologic examination and the reporting of post-treatment pancreatectomies.