PERIOPERATIVE THERAPY IN STAGE IA-III PANCREATIC CANCER - A CROSS-VALIDATION OF THE NATIONAL CANCER DATABASE (NCDB) AND THE GERMAN CANCER REGISTRY OF THE WORKING GROUP OF GERMAN CANCER CENTERS (WGCC/ADT)
Louisa Bolm*1,3, Sergii Zemskov2, Maria C. Zeller3, Taisuke Baba1, Jorge Roldan1, Jon Michael Harrison1, Natalie Petruch1,3, Ekaterina Petrova3, Hryhoriy Lapshyn3, Rüdiger Braun3, Alexander Kirichenko4, Kim C. Honselmann3, Dirk Rades3, Tobias Keck3, Carlos Férnandez-Del Castillo1, Ulrich F. Wellner3, Rodney Wegner4
1Department of Surgery, Massachusetts General Hospital, Boston, MA; 2Natsional'nii meditsnii universitet imeni O O Bogomoltsa, Kyiv, Ukraine; 3Universitatsklinikum Schleswig Holstein - Campus Lubeck, Lubeck, Schleswig-Holstein, Germany; 4Allegheny Health Network, Pittsburgh, PA
Introduction: The aim of this study is to assess concepts and outcome of perioperative treatment regimens in stage IA-III pancreatic cancer in a cross-validation of the German Cancer Registry of the German Working Group of Cancer Centers (WGCC/ADT) and the National Cancer Database (NCDB).
Methods and Material: Patients undergoing oncologic resection for clinical stage IA-III PDAC with operation alone (OP), neoadjuvant therapy and operation (neo+OP), operation and adjuvant therapy (OP+adj) and neoadjuvant therapy, operation and adjuvant therapy (neo+OP+adj) were identified from the WGCC/ADT and NCDB databases between 2000 and 2018. Histopathological parameters were compared for patients undergoing neoadjuvant therapy versus upfront resection. Long-term overall survival rates associated with perioperative treatment regimens were analyzed after prospensity score-based matching.
Results: A total of 1611 patients from the WGCC/ADT database and 29081 patients from the NCDB with oncologic resection for stage IA-III PDAC were included. Neoadjuvant therapy was associated with downstaging of T and N stage in both registries. While neo+OP and neo+OP+adj failed to show a benefit in OS as compared to OP alone for stage IA-IIA patients in the WGCC/ADT registry, OS rates were improved for stage IIB-III patients with neo+OP (10.0m vs. 18.2m, HR 0.746, 95%CI 0.530-0.978, p=0.043) and neo+OP+adj (10.0m vs. 19.9m, HR 0.559, 95%CI 0.398-0.784, p=0.010). In both stage IA-IIA and stage IIB-III patients neo+OP (p<0.001) and neo+OP+adj (p<0.001) improved OS rates as compared to OP alone in the NCDB registry. Neo+OP was associated with prolonged overall survival rates as compared to OP+adj for both stage IA-IIA (27.1m vs. 25.3m, HR 1.066, 95%CI 1.010-1.126, p<0.001) and IIB-III patients (25.8m vs. 20.8m, HR 1.305, 95%CI 1.225-1.390, p<0.001). There was no difference in overall survival for either stages between neo+OP and OP+adj in the WGCC/ADT registry. In the NCDB registry, neo+OP+adj was associated with improved overall survival rates as compared to neo+OP for both stage IA-IIA (27.1m vs. 36.6m, HR 0.716, 95%CI 0.614-0.836, p<0.001) and IIB-III patients (25.8m vs. 28.6m, HR 0.860, 95%CI 0.717-0.978, p<0.001). There was no difference in overall survival for either stages between neo+OP and neo+OP+adj in the WGCC/ADT registry. Neoadjuvant radiochemotherapy was not associated with improved OS as compared to neoadjuvant chemotherapy alone in either registry.
Conclusion: The cross-validation study of the NCDB and WGCC/ADT registries demonstrated a survival benefit with neoadjuvant therapy in both stage IA-IIA and stage IIB-III PDAC. Neoadjuvant therapy combined with adjuvant therapy is associated with improved overall survival as compared to neoadjuvant or adjuvant therapy alone. Concepts and outcomes of perioperative therapy remained consistent in both registries.
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