K. Ang1, N. Goel1, M. Kilcoyne1, A. Nadler1, W. H. Ward1, J. Farma1, A. Karachristos1, N. Esnaola1, J. P. Hoffman1, S. Reddy1 1Fox Chase Cancer Center,Department Of Surgical Oncology,Philadelphia, PA, USA
Introduction: Increased BMI in patients with pancreatic cancer undergoing pancreatic resection who has been associated with increased intra-operative and post-operative complications. However, the effects of BMI on patients that have undergone total neoadjuvant therapy (TNT) have yet to be investigated. All of the patients in this study have undergone TNT, an institutional practice where patients receive systemic chemotherapy and chemoradiation, followed by definitive surgical resection if there is no evidence of metastatic disease. The objective of this study is to evaluate the association of BMI with response and postoperative complications in patients who underwent TNT.
Methods: A retrospective review of an institutional database at a tertiary care cancer center was undertaken to evaluate patients undergoing pancreatic resection from 2000 to 2017 who completed TNT and had pretreatment documented BMI. Clinical and pathologic data were collected including: overall survival, CA19-9 response, and R0 resection. Comparative analysis was performed with chi-square and survival outcomes were assessed using Kaplan-Meier.
Results: The analytic cohort consisted of 57 patients. Patients with normal BMI (NBMI) (18.5 – 24.9; n=26) and overweight/obese (OBMI) (BMI > 25; n=30) at the time of diagnosis were included in the final analysis. The median age at diagnosis was 67 years old (range 38 – 82). Twenty-nine (50.9%) of the patients were female. Fifty-two (91%) were Caucasian, 4 (7%) patients were African American, and 1 patient (1.8%) was Asian.
The median initial CA19-9 prior TNT was 254 (0-35 U/mL) for the NBMI cohort, and 127 for the OBMI cohort (p=0.880). For the NBMI cohort, 63% (n=17) achieved a >50% decrease in CA19-9 levels, 19% (n=5) achieved <50% decrease, 4%% (n=1) had no change or an increase. For the OBMI cohort, 47% (n=14) achieved >50% decrease, 20% (n=6) achieved <50% decrease, 10% (n=3) had no change or an increase. Complications from TNT occurred in a higher proportion of OBMI patients (43%; n=13) than in NBMI patients (41%; n=11), (p=0.023). A breakdown of incidences of each particular adverse effect is illustrated in Table 1. Surgical site infections occurred in 29.6% of NBMI patients (n=8) and in 20% (n=6) of OBMI patients (p=0.541). Length of hospital stay following surgery was 8 days for the NBMI patients compared to 10 days for OBMI patients (p=0.88). The median overall survival for the NBMI cohort was 41.2 months with a 5-year survival rate of 21.2%, while the median overall survival for patients in the OBMI cohort was 37.4 months with a 5-year survival rate of 6.5% (p=0.096).
Conclusions: NBMI patients experienced less complications from TNT than OBMI patients. The borderline significant difference in overall survival between the NBMI cohort and the OBMI warrants further investigation with a larger sample size.
