Neoadjuvant chemotherapy is associated with improved survival in patients with left-sided pancreatic adenocarcinoma.
Publication/Presentation Date
12-1-2020
Abstract
BACKGROUND: Neoadjuvant chemotherapy is used infrequently in the management of distal pancreatic cancers. We investigated outcomes associated with neoadjuvant chemotherapy or up-front surgery in patients undergoing distal pancreatectomy.
METHODS: The National Cancer Database (2004-2016) was queried for patients with pancreas cancer who underwent distal pancreatectomy. Demographics, clinical characteristics, postoperative outcomes, pathologic outcomes, and overall survival were analyzed by univariate and multivariate analysis.
RESULTS: Six thousand five-hundred and twenty-three patients were included, including 5,643 who underwent up-front distal pancreatectomy and 880 who received neoadjuvant therapy. Factors associated with receipt of neoadjuvant chemotherapy included care at academic/research programs, higher education level, higher clinical T stage, higher clinical N stage, and elevated carbohydrate antigen 19-9 level. Patients who received neoadjuvant therapy had fewer positive lymph nodes, higher margin-negative resection rate, lower 30-day readmission rate, and lower 90-day mortality rate. Patients who received neoadjuvant therapy had longer median overall survival (28.8 vs 22.0 months; P < .001). On multivariate analysis, neoadjuvant therapy remained independently associated with improved survival (hazards ratio, 0.72; 95% confidence inteval, 0.63-0.82; P < .001).
CONCLUSIONS: Neoadjuvant therapy in patients with left-sided pancreatic cancers is associated with improved pathologic outcomes as well as longer overall survival. Neoadjuvant therapy should be considered in all patients with PDAC regardless of tumor location.
Volume
122
Issue
8
First Page
1595
Last Page
1603
ISSN
1096-9098
Published In/Presented At
Ocuin, L. M., Hardacre, J. M., Ammori, J. B., Rothermel, L. D., Mohamed, A., Selfridge, J. E., Bajor, D., & Winter, J. M. (2020). Neoadjuvant chemotherapy is associated with improved survival in patients with left-sided pancreatic adenocarcinoma. Journal of surgical oncology, 122(8), 1595–1603. https://doi.org/10.1002/jso.26196
Disciplines
Medicine and Health Sciences
PubMedID
32844445
Department(s)
Department of Surgery, Lehigh Valley Topper Cancer Institute
Document Type
Article
