title: Defining the optimal timing of adjuvant therapy for resected pancreatic adenocarcinoma: A statewide cancer registry analysis.
abstract: BACKGROUND
  Long-term results of the ESPAC-3 trial suggest that while completing adjuvant therapy (AT) is necessary after resection of pancreatic ductal adenocarcinoma (PDAC), early initiation (within 8 weeks) may not be associated with improved overall survival (OS). The primary aim of this study was to evaluate the OS impact of early versus late AT in a statewide analysis.
  
  
  METHODS
  Patients with stages I-III PDAC in the Kentucky Cancer Registry (KCR) from 2004 to 2013, were evaluated. Those undergoing pancreatectomy were stratified into two groups ("early," <8 weeks, vs. "late," 8-16 weeks).
  
  
  RESULTS
  Of 2,221 diagnosed patients with stages I-III, 831 (37.4%) underwent pancreatectomy upfront. Of these, only 420 (50.5%) received AT. Initiation date of AT was not associated with OS (median OS: early, 20.2 vs. late, 19.0 months, P = 0.97). On multivariate analysis, factors that affected OS included stage (II, HR-1.82, P = 0.017; III, HR-3.77, P < 0.001), node positivity (HR-1.51, P = 0.004), poorly/undifferentiated grade (HR-1.34; P = 0.011), but not AT initiation date.
  
  
  CONCLUSIONS
  In this statewide analysis, there was no difference in OS between early and late AT initiation for resected PDAC. The ideal window for AT initiation remains unknown as tumor biology continues to trump regimens from the past decade. J. Surg. Oncol. 2016;114:451-455. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky.
authors.forename: Hayder
authors.initials: H
authors.lastname: Saeed
authors.affiliation: Department of Surgery, University of Kentucky Medical Center, Lexington, Kentucky.
authors.forename: Dima
authors.initials: D
authors.lastname: Hnoosh
authors.affiliation: Department of Biostatistics, College of Public Health, Lexington, Kentucky.|Kentucky Cancer Registry, Markey Cancer Center, Lexington, Kentucky.
authors.forename: Bin
authors.initials: B
authors.lastname: Huang
authors.affiliation: Department of Biostatistics, College of Public Health, Lexington, Kentucky.|Kentucky Cancer Registry, Markey Cancer Center, Lexington, Kentucky.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Durbin
authors.affiliation: Department of Surgery, University of Kentucky Medical Center, Lexington, Kentucky.
authors.forename: Patrick C
authors.initials: PC
authors.lastname: McGrath
authors.affiliation: Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky.
authors.forename: Philip
authors.initials: P
authors.lastname: Desimone
authors.affiliation: Department of Surgery, Oregon Health and Science University, Portland, Oregon.
authors.forename: Erin
authors.initials: E
authors.lastname: Maynard
authors.affiliation: Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky.
authors.forename: Lowell B
authors.initials: LB
authors.lastname: Anthony
authors.affiliation: Department of Surgery, University of Kentucky Medical Center, Lexington, Kentucky.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Dineen
authors.affiliation: Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hosein
authors.affiliation: Department of Surgery, University of Kentucky Medical Center, Lexington, Kentucky.
authors.forename: Ching-Wei D
authors.initials: CW
authors.lastname: Tzeng
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012042:Registries; D013997:Time Factors
keywords: adjuvant therapy; delay; pancreatic adenocarcinoma; pancreatic cancer; timing