Early discontinuation of adjuvant chemotherapy in patients with early-stage pancreatic cancer correlates with inferior survival: A multicenter population-based cohort study

Abstract

Background: The current study aimed to determine the association between timing and completion of adjuvant chemotherapy and outcomes in real-world patients with early-stage pancreatic cancer.

Methods: In this multi-center cohort study patients with early-stage pancreatic cancer who were diagnosed from 2007-2017 and underwent complete resection in the province of Saskatchewan were examined. Cox proportional multivariate analyses were performed for correlation with recurrence and survival.

Results: Of 168 patients, 71 eligible patients with median age of 69 years and M:F of 37:34 were identified. Median time to the start of adjuvant therapy from surgery was 73 days. Of all patients, 49 (69%) patients completed adjuvant chemotherapy and 22 (31%) required early treatment discontinuation. Median recurrence-free survival of patients who completed treatment was 22 months (95%CI:15.8-28.2) vs. 9 months (3.3-14.7) if treatment was discontinued early (P<0.001). Median overall survival of those who completed treatment was 33 (17.5-48.5) vs. 16 months (17.5-48.5) with early treatment discontinuation (P<0.001). In the multivariate analysis, treatment discontinuation was significantly correlated with recurrent disease, hazard ratio (HR), 2.57 (1.41-4.68), P = 0.002 and inferior survival, HR, 2.55 (1.39-4.68), P = 0.003. No correlation between treatment timing and survival was noted.

Conclusions: Early discontinuation but not the timing of adjuvant chemotherapy correlates with inferior outcomes.

Fig 1. Flow diagram of eligible patients with pancreatic cancer eligible for the study.

Fig 2

A. Kaplan-Meier recurrence-free survival curves of the patients who received adjuvant chemotherapy within 56 days of surgery to those who received adjuvant therapy beyond 56 days. B. Kaplan-Meier overall survival curves of the patients who received adjuvant chemotherapy within 56 days of surgery to those who received adjuvant therapy beyond 56 days.

Fig 3

A. Kaplan-Meier recurrence-free survival curves of the patients who completed adjuvant chemotherapy to those who did not complete adjuvant therapy. B. Kaplan-Meier overall survival curves of patients who received planned adjuvant chemotherapy to those did not complete adjuvant therapy.