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
. 2022 Sep 28:11:100136.
doi: 10.1016/j.sipas.2022.100136. eCollection 2022 Dec.

Neoadjuvant chemotherapy improves outcomes in resectable pancreatic adenocarcinoma

Wade Christopher  1 , Sean Nassoiy  1 , Rebecca Marcus  1 , Jennifer Keller  1 , Shu-Ching Chang  2 , Trevan Fischer  1 , Anton Bilchik  1 , Melanie Goldfarb  1
Affiliations

Neoadjuvant chemotherapy improves outcomes in resectable pancreatic adenocarcinoma

Wade Christopher et al. Surg Pract Sci. .

Abstract

Background/objectives: Systemic chemotherapy is recommended for all stages of pancreatic ductal adenocarcinoma (PDAC), with a recent shift towards neoadjuvant chemotherapy (NAC) for resectable PDAC. The objective of this study was to compare outcomes of NAC versus AC for early stage resectable PDAC in the NCDB. Methods: Patients aged 18 or older with stage I or II PDAC in the National Cancer Database (NCDB) from 2010 to 2017 were identified. Logistic regression evaluated oncologic outcomes. Kaplan-Meier method followed by Cox proportional-hazards regression with inverse probability of treatment weighting (IPTW) using propensity score matching was used to compare overall survival (OS).

Results: NAC led to a 13% risk reduction of a positive resection margin (OR:0.87; 95%CI 0.78-0.97), and a 59% decreased risk of positive lymph nodes (OR:0.41; 95%CI 0.38-0.45). The median OS for all patients treated with NAC was 2.56 years versus 1.95 years for surgery +/- AC (p< 0.001). NAC had an OS benefit for all patients (HR:0.80; 95%CI 0.78-0.83), as well as for Stage I (HR:0.89; 95%CI 0.84-0.94) and Stage II patients (HR:0.71; 95%CI 0.68-0.75).

Conclusions: NAC appears to be associated with a survival benefit for patients with resectable PDAC. NAC also decreased the risk of a positive resection margin and positive lymph nodes at the time of surgery.

Keywords: Neoadjuvant; Pancreas; Pancreatic adenocarcinoma; Resectable.

PubMed Disclaimer

Conflict of interest statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. We confirm that none of the authors listed below have conflicts of interest to disclose.

Figures

Fig 1
Fig. 1
Data Flow Chart.
Fig 2
Fig. 2
Number (Left) and percentage (Right) in the utilization of neoadjuvant chemotherapy among patients with pancreatic cancer over time.
Fig 3
Fig. 3
Multivariable Cox proportional-hazards models for comparing overall survival between NAC versus upfront surgery groups for clinical stage I-II (A), clinical stage I (B) patients, and clinical stage II (C) patients.
Fig 3
Fig. 3
Multivariable Cox proportional-hazards models for comparing overall survival between NAC versus upfront surgery groups for clinical stage I-II (A), clinical stage I (B) patients, and clinical stage II (C) patients.
Fig 3
Fig. 3
Multivariable Cox proportional-hazards models for comparing overall survival between NAC versus upfront surgery groups for clinical stage I-II (A), clinical stage I (B) patients, and clinical stage II (C) patients.
See this image and copyright information in PMC

References

    1. Siegel R.L., Miller K.D., Jemal A. Cancer statistics. CA Cancer J Clin 2018. 2018;68:7–30. - PubMed
    1. Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: incidence - SEER Research Data, 13 Registries, Nov 2020 Sub (1975-2018) - Linked To County Attributes - Time Dependent (1990-2018) Income/Rurality, 1969-2019 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, released April 2021, based on the November 2020 submission.
    1. Gillen S., Schuster T., Meyer, et al. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med. 2010;7 doi: 10.1371/journal.pmed.1000267. - DOI - PMC - PubMed
    1. National Comprehensive Cancer Network. Pancreatic adenocarcinoma 2.2021. https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. 24 May 2021.
    1. Murphy J.E., Wo J.Y., Ryan D.P., et al. Total Neoadjuvant Therapy With FOLFIRINOX followed by individualized chemoradiotherapy for borderline resectable pancreatic adenocarcinoma: a Phase 2 clinical trial. JAMA Oncol. 2018 Jul 1;4(7):963–969. - PMC - PubMed

LinkOut - more resources