UTILIZATION OF NEOADJUVANT THERAPY IN ELDERLY PATIENTS WITH PANCREATIC DUCTAL ADENOCARCINOMA: AN NCDB STUDY
Mansour E. Riachi*, Sarah R. Kaslow, Mahip Jrewal, Anthony Sorrentino, Daniel B. Hewitt, Megan Winner, Steven M. Cohen, Brian J. Kaplan, John Allendorf, Diane M. Simeone, Theodore H. Welling, Christopher L. Wolfgang, Greg D. Sacks, Ammar A. Javed
Hepatobiliary Surgery, NYU Langone Health, New York, NY
Introduction:
Over the last decade a neoadjuvant-first approach has garnered increasing popularity in the management of pancreatic ductal adenocarcionma (PDAC). Systemic therapy is associated with considerable chemotoxocity, and chemotherapy intolerance is associated with performance status and comordibidities. Over a third of patients diagnosed with PDAC are aged ≥ 75 years. The aim of this study was to assess the utlization of neoadjuvant therapy (NAT) and its impact on survival in this cohort.
Methods:
The National Cancer Database (NCDB) was used to identify patients diagnosed with PDAC between 2010 and 2017 who underwent pancreatectomy. Patients were staged using the American Joint Committee on Cancer staging system. Patients with stage IV disease or those with missing data on stage or NAT were excluded. Demographic and clinicopathological characteristics were assessed using Chi Squared Test. Factors associated with receipt of NAT were identified using logistic regression. The association between NAT and hazard of mortality was assessed using Cox proportional hazards model. Median overall survival (OS) was examined.
Results:
A total of 26,346 patients were included of whom 21% were ≥75 years of age. Younger patients were more likely to have a Charlson-Deyo comorbidity score of 0 (64% vs. 60%, p<0.001). No significant differences were observed between the two cohorts in terms of tumor size, margin status, lymphovascular invasion and grade (all p-values>0.05).
NAT was administered in 12% of the elderly patients as compared to 24% in the younger cohort (p<0.001). After controlling for sex, race, tumor size, grade, clinical stage, and Charlson-Deyo comorbiditiy score, elderly patients were less likely to receive NAT (OR:0.46, 95%CI: 0.40-0.53, p<0.001). Charlson-Deyo score was not associated with receipt of NAT in the elderly cohort (p=0.986). On multivariate analysis, NAT was associated with improved survival in both the elderly (HR:0.80, 95%CI: 0.70-0.92, p=0.002) and younger cohort (HR:0.78, 95%CI: 0.73-0.83, p<0.001). In the younger cohort, median OS was 30.1 months for patients that received NAT and 23.2 months for those that did not (p<0.001) . In the elderly, median OS was 24.9 months for patients that received NAT and 17.8 months for those that did not (p<0.001).
Conclusion:
NAT is associated with improved OS in patients with PDAC who are ≥75 years of age compared to those that did not receive NAT. However, its utilization in this cohort remains significantly lower than in their younger counterparts. Comorbidities are not associated with the receipt of NAT in the older cohort. Furture studies are required to identify factors driving these lower rates which when addressed, could potentially help improve management in these patients.
Back to 2023 Abstracts