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. 2025 Jul 2;56(1):145.
doi: 10.1007/s12029-025-01269-x.

Role of Neoadjuvant Therapy for Patients with Adenosquamous Carcinoma of the Pancreas: Outcomes from the National Cancer Database

Amanda K Walsh  1 , Diamantis I Tsilimigras  1 , Alex B Blair  1 , Susan Tsai  1 , Timothy M Pawlik  1 , Ashish Manne  2 , Shafia Rahman  2 , Eric D Miller  3 , Kenneth L Pitter  3 , Jordan M Cloyd  4
Affiliations

Role of Neoadjuvant Therapy for Patients with Adenosquamous Carcinoma of the Pancreas: Outcomes from the National Cancer Database

Amanda K Walsh et al. J Gastrointest Cancer. .

Abstract

Purpose: Pancreatic adenosquamous carcinoma (PASC) is a rare and aggressive form of pancreatic cancer whose management often follows its more common pancreatic ductal adenocarcinoma (PDAC) counterpart. While neoadjuvant therapy (NT) is increasingly utilized prior to surgery for PDAC, whether patients with PASC experience similar benefits is unclear.

Methods: Using the National Cancer Database (NCDB), all patients with stage I-III PASC who underwent surgical resection between 2006 and 2020 were included. Patient and tumor characteristics and overall survival (OS) of patients who underwent surgery first (SF) were compared to those who received NT prior to surgery.

Results: Among 1191 patients with PASC who underwent curative intent resection, 208 (17.5%) received NT, whereas 983 (82.5%) underwent SF. Overall, NT was associated with improved OS compared with an SF approach (median 20.7 vs 15.9 months; p = 0.03). On multivariable Cox regression analysis, factors independently associated with improved OS included treatment at an academic/research facility, receipt of NT, and receipt of adjuvant therapy. Factors associated with decreased OS included Black race, positive surgical margins, worse comorbidity score, and higher cancer stage. There was no significant difference in OS between patients who received NT chemotherapy and radiation vs NT chemotherapy alone.

Conclusion: Among patients with localized PASC, the receipt of NT prior to surgical resection was associated with improved OS outcomes. Future research is needed to clarify the optimal neoadjuvant treatment regimen, including the role of preoperative radiation, to enhance response to therapy and improve long-term outcomes.

Keywords: National Cancer Database; Neoadjuvant therapy; Pancreatic adenosquamous carcinoma; Pancreatic cancer; Surgery first.

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Conflict of interest statement

Declarations. Ethics Approval: Due to the deidentified nature of the data, this research is considered exempt from IRB review and informed consent. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Percentage of patients treated with NT versus SF from 2006 to 2020
Fig. 2
Fig. 2
Overall survival of patients with pancreatic adenosquamous carcinoma receiving NT versus SF
Fig. 3
Fig. 3
Overall survival outcomes comparing patients treated with NT chemotherapy versus NT chemotherapy and radiation
See this image and copyright information in PMC

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