NEOADJUVANT THERAPY VERSUS SURGERY FIRST FOR RESECTABLE PANCREATIC CANCER
Tariq Almerey*, David Hyman, Zhuo Li, Mary Tice, Gina Porrazzo, John Stauffer
Surgery, Mayo Foundation for Medical Education and Research, Rochester, MN
The use of neoadjuvant therapy (NAT) is increasing substantially in the settings of borderline and locally advanced pancreatic ductal adenocarcinoma (PDAC). However, the role of NAT in resectable PDAC is still unclear due to the lack of evidence in the literature. The aim of this study is to compare the long-term outcomes of NAT versus surgery first (SF) for resectable PDAC.
All patients with resectable PDAC between 1/1/2010-12/31/2021 were reviewed and included in the study. Demographics, operative/perioperative details, and pathology details were gathered. Data pertaining to long term outcomes including; overall survival and recurrence-free survival were obtained. Those undergoing SF were compared to those who had NAT. Categorical variables were summarized as frequency (percentage) and compared between the SF and NAT groups using Chi-squared test. Continuous variables were reported as median (range) and mean (standard deviation) and compared between the two groups using Wilcoxon rank sum test. Kaplan-Meier method was used to estimate the freedom from events at 1, 2, 3,4 and 5 years and corresponding Kaplan-Meier curves were drawn (Figure 1,2). Cox regression model were used to identify risk factors that were associated with the outcomes. All tests were two-sided with p value <0.05 considered statistically significant.
252 subjects with resectable PDAC were included in this review. 44 patients had NAT versus 208 with SF approach. There was no significant difference in 5 year overall survival between subjects who received NAT vs SF (58.2% vs 37.8%, p=0.65). Similarly, there was no significant difference in 5 year recurrence free survival (51.9% vs 45.4%, p=0.97). T/N stage, margins, ASA class, estimated blood loss (EBL), and perioperative blood transfusion were associated with decreased survival on univariate analysis. On multivariate analysis, this association remained statistically significant with the exception of EBL and blood transfusion.
Although there is a theoretical benefit of testing tumor biology by proceeding with NAT versus SF in resectable PDAC, this did not translate to improved overall and recurrence free survival at 5 years in this study. Further studies with more patients, prolonged follow up, and correlating molecular profiling of the tumor with NAT outcomes are warranted to detect the benefit of NAT in resectable PDAC.
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