Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 1;279(2):331-339.
doi: 10.1097/SLA.0000000000005925. Epub 2023 May 25.

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

Toshitaka Sugawara  1   2 , Salvador Rodriguez Franco  1 , Samantha Sherman  3 , Robert J Torphy  4 , Kathryn Colborn  1   5   6 , Oskar Franklin  1   7 , Jun Ishida  1 , Samuele Grandi  1 , Mohammed H Al-Musawi  4 , Ana Gleisner  1   8 , Richard D Schulick  6   8 , Marco Del Chiaro  1   8
Affiliations

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

Toshitaka Sugawara et al. Ann Surg. .

Abstract

Objective: The objective of this study was to assess the association of survival with neoadjuvant chemotherapy (NAC) in resectable pancreatic adenocarcinoma (PDAC).

Background: The 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.

Methods: Patients 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.

Results: In 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.

Conclusions: The findings suggest that multiagent NAC followed by resection is associated with improved survival compared with upfront surgery.

PubMed Disclaimer

Conflict of interest statement

K.C. reported receiving grants from the National Institutes of Health, Patient-Centered Outcomes Research Institute, and Agency for Healthcare Research and Quality during the conduct of the study. R.D.S. reported being the inventor of a patent licensed to DynamiCure and receiving laboratory equipment from Haemonetics outside the submitted work. M.D.C. reported receiving an industry grant (Haemonetics Inc.) to conduct a multicenter study to evaluate the prognostic implications of TEG in pancreatic cancer, and being co-principal investigator of a Boston Scientific-sponsored international multicenter study on the use of intraoperative pancreatoscopy of patients with IPMN. The remaining authors report no conflicts of interest.

References

    1. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021. CA Cancer J Clin. 2021;71:7–33.
    1. Khorana AA, Mangu PB, Berlin J, et al. Potentially curable pancreatic cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2016;34:2541–2556.
    1. Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013;310:1473–1481.
    1. Tatarian T, Jiang W, Leiby BE, et al. Cytoplasmic HuR status predicts disease-free survival in resected pancreatic cancer: a post-hoc analysis from the International Phase III ESPAC-3 Clinical Trial. Ann Surg. 2018;267:364–369.
    1. Uesaka K, Boku N, Fukutomi A, et al. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet. 2016;388:248–257.