• Annals of surgery · Feb 2024

    Neoadjuvant Chemotherapy versus Upfront Surgery for Resectable Pancreatic Adenocarcinoma: An Updated Nationwide Study.

    • Toshitaka Sugawara, Salvador Rodriguez Franco, Samantha Sherman, Robert J Torphy, Kathryn Colborn, Oskar Franklin, Jun Ishida, Samuele Grandi, Mohammed H Al-Musawi, Ana Gleisner, Richard D Schulick, and Marco Del Chiaro.
    • Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO.
    • Ann. Surg. 2024 Feb 1; 279 (2): 331339331-339.

    ObjectiveThe objective of this study was to assess the association of survival with neoadjuvant chemotherapy (NAC) in resectable pancreatic adenocarcinoma (PDAC).BackgroundThe early control of potential micrometastases and patient selection using NAC has been advocated for patients with PDAC. However, the role of NAC for resectable PDAC remains unclear.MethodsPatients with clinical T1 and T2 PDAC were identified in the National Cancer Database from 2010 to 2017. Kaplan-Meier estimates, and Cox regression models were used to compare survival. To address immortal time bias, landmark analysis was performed. Interactions between preoperative factors and NAC were investigated in subgroup analyses. A propensity score analysis was performed to compare survival between multiagent NAC and upfront surgery.ResultsIn total, 4041 patients were treated with upfront surgery and 1,175 patients were treated with NAC (79.4% multiagent NAC, 20.6% single-agent NAC). Using a landmark time of 6 months after diagnosis, patients treated with multiagent NAC had longer median overall survival compared with upfront surgery and single-agent NAC. (35.8 vs 27.1 vs 27.4 mo). Multiagent NAC was associated with lower mortality rates compared with upfront surgery (adjusted hazard ratio, 0.77; 95% CI, 0.70-0.85), whereas single-agent NAC was not. The association of survival with multiagent NAC were consistent in analyses using the matched data sets. Interaction analysis revealed that the association between multiagent NAC and a lower mortality rate did not significantly differ across age, facility type, tumor location, CA 19-9 levels, and clinical T/N stages.ConclusionsThe findings suggest that multiagent NAC followed by resection is associated with improved survival compared with upfront surgery.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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