Factors influencing receipt of adjuvant chemotherapy after surgery for pancreatic cancer: a two-center retrospective cohort study.
OBJECTIVE
The addition of adjuvant chemotherapy after surgical resection has improved survival rates for patients with pancreatic ductal adenocarcinoma (PDAC). However, outside clinical trials, many operated patients still do not receive adjuvant chemotherapy due to clinical and tumor-related factors. The aim of this study was to investigate factors that may influence the receipt of adjuvant chemotherapy and the effect on long-term survival.


METHODS
Patients undergoing macroscopically curative resection for PDAC at the University Hospitals in Lund and Linköping, Sweden, between 1 January 2007 and 31 December 2015, were retrospectively reviewed. Clinical and pathological data were compared between adjuvant and non-adjuvant chemotherapy groups and factors affecting chemotherapy receipt were analyzed by multiple logistic regression. Multivariable Cox regression analysis was performed to select predictive variables for survival.


RESULTS
A total of 233 patients were analyzed. Adjuvant chemotherapy was administered to 167 patients (71.7%). The likelihood of receiving adjuvant chemotherapy decreased with age, OR 0.91, 95% CI 0.86-0.95, p < .001. Moreover, patients with severe postoperative complications (Clavien-Dindo grade ≥ III) were less likely to receive adjuvant chemotherapy, OR 0.31, 95% CI 0.14-0.71, p = .005. The presence of lymph node metastases on histopathological reporting was associated with increased likelihood of initiating adjuvant chemotherapy, OR 2.19, 95% CI 1.09-4.40, p = .028. Adjuvant chemotherapy was an independent factor for prolonged survival on multivariable Cox regression analysis, HR 0.45 (95% CI 0.31-0.65), p < .001.


CONCLUSIONS
Age, postoperative complications and the presence of lymph node metastases affect the likelihood of receiving adjuvant chemotherapy after PDAC surgery.
a Department of Surgery, Clinical Sciences Lund , Lund University and Skåne University Hospital , Lund , Sweden.
Daniel
D
Åkerberg
b Department of Surgery and Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden.
Bergthor
B
Björnsson
a Department of Surgery, Clinical Sciences Lund , Lund University and Skåne University Hospital , Lund , Sweden.
Daniel
D
Ansari
D000367:Age Factors; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000628:therapy*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016019:Survival Analysis; D013548:Sweden
Pancreatic cancer; adjuvant chemotherapy; age; lymph node metastases; postoperative complications; surgery; survival