Predictors of Disease Progression or Performance Status Decline in Patients Undergoing Neoadjuvant Therapy for Localized Pancreatic Head Adenocarcinoma.

INTRODUCTION: Neoadjuvant therapy (NT) is a growing strategy in localized head pancreatic adenocarcinoma (PDC). However, a significant portion of NT patients do not reach resection due to disease progression or performance status decline. We sought to identify predictors of disease progression or performance status decline during NT. METHODS: Retrospective cohort analysis of consecutive patients with localized head-PDC who received NT at a tertiary referral center between 2005 and 2017. Univariate and multivariate (MVA) analysis were performed to identify factors associated with disease progression or performance status decline during NT preventing surgical resection. RESULTS: A total of 479 patients with PDC underwent NT; 71.2% proceeded to surgery, 20.5% had disease progression, and 8.3% experienced performance status decline. Median OS was 28 [95% confidence interval (CI) 23.8-32.3], 12.8 (CI 11.2-14.3), and 6.9 (CI 5.2-9.4) months, respectively (p < 0.05). MVA predictors of disease progression were larger clinical CT tumor size [odds ratio (OR) 1.03, CI 1.0-1.1], unplanned change in NT regimen (OR 2.6, CI 1.0-6.9), hospital admission during NT (OR 2.2, CI 1.2-3.9), and lack of CA19-9 response (OR 4.4, CI 4.0-8.4). MVA predictors of performance status decline were increasing age (OR 1.1, CI 1.0-1.2), presence of pre-NT diabetes (OR 3.8, CI 1.3-11.3), hospital admission during NT (OR 14.0, CI 3.9-49.8), and lack of CA19-9 response (OR 4.7, CI 1.4-15.5). CONCLUSIONS: This analysis identifies several predictors of disease progression and performance status decline during NT for PDC. Knowledge of these factors informs the physician on the risks and limitations of NT and provides insight to guide patient selection and counseling.