Neoadjuvant Therapy Followed by Resection Versus Upfront Resection for Resectable Pancreatic Cancer: A Propensity Score Matched Analysis.
Purpose To compare overall survival between patients who received neoadjuvant therapy (NAT) followed by resection and those who received upfront resection (UR)-as well as a subgroup of UR patients who also received adjuvant therapy-for early-stage resectable pancreatic adenocarcinoma. Patients and Methods Adult patients with resected, clinical stage I or II adenocarcinoma of the head of the pancreas were identified in the National Cancer Database from 2006 to 2012. Patients who underwent NAT followed by curative-intent resection were matched by propensity score with patients whose tumors were resected upfront. Overall survival was compared by using a Cox proportional hazards regression model. Early postoperative and oncologic outcomes were evaluated. Results We identified 15,237 patients with clinical stage I or II resected pancreatic head adenocarcinoma. From the NAT group, 2,005 patients (95%) were matched with 6,015 patients who underwent UR. The NAT group was associated with improved survival compared with UR (median survival, 26 months v 21 months, respectively; stratified log-rank P < .01; hazard ratio, 0.72; 95% CI, 0.68 to 0.78). Patients in the UR group had higher pathologic T stage (pT3 and T4: 86% v 73%; P < .01), higher positive lymph nodes (73% v 48%; P < .01), and higher positive resection margin (24% v 17%; P < .01). Compared with a subset of UR patients who received adjuvant therapy, NAT patients had a better survival (adjusted hazard ratio, 0.83; 95% CI, 0.73 to 0.89). Conclusion NAT followed by resection has a significant survival benefit compared with UR in early-stage, resected pancreatic head adenocarcinoma. These findings support the use of NAT, particularly as a patient selection tool, in the management of resectable pancreatic adenocarcinoma.
All authors: University of Texas Southwestern Medical Center, Dallas, TX.
Ali A
AA
Mokdad
All authors: University of Texas Southwestern Medical Center, Dallas, TX.
Rebecca M
RM
Minter
All authors: University of Texas Southwestern Medical Center, Dallas, TX.
Hong
H
Zhu
All authors: University of Texas Southwestern Medical Center, Dallas, TX.
Mathew M
MM
Augustine
All authors: University of Texas Southwestern Medical Center, Dallas, TX.
Matthew R
MR
Porembka
All authors: University of Texas Southwestern Medical Center, Dallas, TX.
Sam C
SC
Wang
All authors: University of Texas Southwestern Medical Center, Dallas, TX.
Adam C
AC
Yopp
All authors: University of Texas Southwestern Medical Center, Dallas, TX.
John C
JC
Mansour
All authors: University of Texas Southwestern Medical Center, Dallas, TX.
Michael A
MA
Choti
All authors: University of Texas Southwestern Medical Center, Dallas, TX.
Patricio M
PM
Polanco
D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000379:methods; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010179:Pancreas / Q000187:drug effects / Q000528:radiation effects / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000628:therapy*; D057216:Propensity Score; D016016:Proportional Hazards Models; D055815:Young Adult