THE EFFECT OF NEOADJUVANT THERAPY ON OVERALL SURVIVAL IN RESECTED PANCREATIC CANCER
William Lancaster*, David Adams, Katherine A. Morgan
Surgery, Medical University of South Carolina, Charleston, SC
Background:
Neoadjuvant chemotherapy is not the standard treatment for resectable pancreatic cancer though it is employed with increasing frequency and there is evidence of improved survival. We sought to examine the influence of neoadjuvant therapy in patients undergoing surgical treatment for pancreatic cancer.
Methods:
We analyzed the most recent National Cancer Database Public Use File which includes patients diagnosed with pancreatic adenocarcinoma from 2004 to 2014. We included patients with clinical stage I through III who were treated with surgical resection. Patients were stratified according to treatment sequence (upfront surgery vs. neoadjuvant chemotherapy). We analyzed overall survival (OS) using the log rank test to compare Kaplan Meier curves and Cox proportional hazards to control for confounding variables; we estimated stratified models to assess for interaction between neoadjuvant chemotherapy and other relevant covariates.
Results
We identified 36,150 patients who met inclusion criteria. Patients who received neoadjuvant therapy (9,805) represented 27% of the study cohort. Median overall survival for the entire cohort was 22 months. In unadjusted analysis, neoadjuvant therapy was significantly associated with OS, median neoadjuvant vs. upfront surgery 26 vs. 21 months (p<0.001). Factors associated with worse overall survival were: older age, greater comorbidity ( (HR 1.08, 95% CI 1.06-1.09), and increasing stage of disease (HR 1.083, 95% 1.076-1.093). Controlling for these factors, neoadjuvant therapy was associated with significantly improved overall survival (HR 1.195, 95% CI 1.158-1.253)
Conclusion
Survival remains poor in pancreatic cancer, including patients that are candidates for surgery. Neoadjuvant chemotherapy is employed with increasing frequency in resectable pancreatic cancer and is associated with a significant increase in overall survival.
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