Comparison of overall survival between preoperative chemotherapy and chemoradiotherapy for resectable pancreatic adenocarcinoma

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Abstract

Background: Preoperative therapy is being increasingly used in the treatment of resectable pancreatic cancer. Because there are only limited data on the optimal preoperative regimen, we compared overall survival (OS) between preoperative chemotherapy (CT) and preoperative chemoradiotherapy (CRT) in resectable pancreatic adenocarcinoma. Patients and Methods: Patients receiving preoperative therapy and resection for clinical T1–3N0–1M0 adenocarcinoma of the pancreas were identified in the National Cancer Database for 2006 through 2012. We constructed inverse probability of treatment weights to balance baseline group differences, and compared OS between CT and CRT, as well as pathologic and postoperative findings. Results: We identified 1,326 patients (CT: 616; CRT: 710). Differences in OS were not significant between CRT and CT (median survival, 25 vs 26 months; P=.10; weight-adjusted hazard ratio, 0.89; 95% CI, 0.77–1.02). Compared with patients in the CT group, those in the CRT group had lower pathologic T stage (ypT0/T1/T2: 36% vs 21%; P<.01), less lymph node involvement (ypN1: 35% vs 59%; P<.01), and fewer positive resection margins (14% vs 21%; P=.01), but had more postoperative unplanned readmissions (9% vs 6%; P=.01) and increased 90-day mortality (7% vs 4%; P=.03). Those in the CRT group were also less likely to receive postoperative therapy (26% vs 51%; P<.01). Conclusions: Preoperative CT and CRT have similar OS, but CRT is associated with more favorable pathologic features at the cost of higher postoperative morbidity and mortality. Additional trials investigating preoperative therapy are needed for patients with resectable pancreatic cancer.

Original languageEnglish (US)
Pages (from-to)1468-1475
Number of pages8
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume16
Issue number12
DOIs
StatePublished - Dec 1 2018

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Chemoradiotherapy
Adenocarcinoma
Drug Therapy
Survival
Pancreatic Neoplasms
Therapeutics
Weights and Measures
Mortality
Pancreas
Lymph Nodes
Databases
Morbidity

ASJC Scopus subject areas

  • Oncology

Cite this

@article{d32f850ef83b49da95008cd697f7279c,
title = "Comparison of overall survival between preoperative chemotherapy and chemoradiotherapy for resectable pancreatic adenocarcinoma",
abstract = "Background: Preoperative therapy is being increasingly used in the treatment of resectable pancreatic cancer. Because there are only limited data on the optimal preoperative regimen, we compared overall survival (OS) between preoperative chemotherapy (CT) and preoperative chemoradiotherapy (CRT) in resectable pancreatic adenocarcinoma. Patients and Methods: Patients receiving preoperative therapy and resection for clinical T1–3N0–1M0 adenocarcinoma of the pancreas were identified in the National Cancer Database for 2006 through 2012. We constructed inverse probability of treatment weights to balance baseline group differences, and compared OS between CT and CRT, as well as pathologic and postoperative findings. Results: We identified 1,326 patients (CT: 616; CRT: 710). Differences in OS were not significant between CRT and CT (median survival, 25 vs 26 months; P=.10; weight-adjusted hazard ratio, 0.89; 95{\%} CI, 0.77–1.02). Compared with patients in the CT group, those in the CRT group had lower pathologic T stage (ypT0/T1/T2: 36{\%} vs 21{\%}; P<.01), less lymph node involvement (ypN1: 35{\%} vs 59{\%}; P<.01), and fewer positive resection margins (14{\%} vs 21{\%}; P=.01), but had more postoperative unplanned readmissions (9{\%} vs 6{\%}; P=.01) and increased 90-day mortality (7{\%} vs 4{\%}; P=.03). Those in the CRT group were also less likely to receive postoperative therapy (26{\%} vs 51{\%}; P<.01). Conclusions: Preoperative CT and CRT have similar OS, but CRT is associated with more favorable pathologic features at the cost of higher postoperative morbidity and mortality. Additional trials investigating preoperative therapy are needed for patients with resectable pancreatic cancer.",
author = "Mokdad, {Ali A.} and Minter, {Rebecca M} and Yopp, {Adam C} and Matthew Porembka and Wang, {Sam C} and Hong Zhu and Augustine, {Martin M} and Mansour, {John C} and Choti, {Michael A} and Polanco, {Patricio M}",
year = "2018",
month = "12",
day = "1",
doi = "10.6004/jnccn.2018.7068",
language = "English (US)",
volume = "16",
pages = "1468--1475",
journal = "Journal of the National Comprehensive Cancer Network : JNCCN",
issn = "1540-1405",
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number = "12",

}

TY - JOUR

T1 - Comparison of overall survival between preoperative chemotherapy and chemoradiotherapy for resectable pancreatic adenocarcinoma

AU - Mokdad, Ali A.

AU - Minter, Rebecca M

AU - Yopp, Adam C

AU - Porembka, Matthew

AU - Wang, Sam C

AU - Zhu, Hong

AU - Augustine, Martin M

AU - Mansour, John C

AU - Choti, Michael A

AU - Polanco, Patricio M

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background: Preoperative therapy is being increasingly used in the treatment of resectable pancreatic cancer. Because there are only limited data on the optimal preoperative regimen, we compared overall survival (OS) between preoperative chemotherapy (CT) and preoperative chemoradiotherapy (CRT) in resectable pancreatic adenocarcinoma. Patients and Methods: Patients receiving preoperative therapy and resection for clinical T1–3N0–1M0 adenocarcinoma of the pancreas were identified in the National Cancer Database for 2006 through 2012. We constructed inverse probability of treatment weights to balance baseline group differences, and compared OS between CT and CRT, as well as pathologic and postoperative findings. Results: We identified 1,326 patients (CT: 616; CRT: 710). Differences in OS were not significant between CRT and CT (median survival, 25 vs 26 months; P=.10; weight-adjusted hazard ratio, 0.89; 95% CI, 0.77–1.02). Compared with patients in the CT group, those in the CRT group had lower pathologic T stage (ypT0/T1/T2: 36% vs 21%; P<.01), less lymph node involvement (ypN1: 35% vs 59%; P<.01), and fewer positive resection margins (14% vs 21%; P=.01), but had more postoperative unplanned readmissions (9% vs 6%; P=.01) and increased 90-day mortality (7% vs 4%; P=.03). Those in the CRT group were also less likely to receive postoperative therapy (26% vs 51%; P<.01). Conclusions: Preoperative CT and CRT have similar OS, but CRT is associated with more favorable pathologic features at the cost of higher postoperative morbidity and mortality. Additional trials investigating preoperative therapy are needed for patients with resectable pancreatic cancer.

AB - Background: Preoperative therapy is being increasingly used in the treatment of resectable pancreatic cancer. Because there are only limited data on the optimal preoperative regimen, we compared overall survival (OS) between preoperative chemotherapy (CT) and preoperative chemoradiotherapy (CRT) in resectable pancreatic adenocarcinoma. Patients and Methods: Patients receiving preoperative therapy and resection for clinical T1–3N0–1M0 adenocarcinoma of the pancreas were identified in the National Cancer Database for 2006 through 2012. We constructed inverse probability of treatment weights to balance baseline group differences, and compared OS between CT and CRT, as well as pathologic and postoperative findings. Results: We identified 1,326 patients (CT: 616; CRT: 710). Differences in OS were not significant between CRT and CT (median survival, 25 vs 26 months; P=.10; weight-adjusted hazard ratio, 0.89; 95% CI, 0.77–1.02). Compared with patients in the CT group, those in the CRT group had lower pathologic T stage (ypT0/T1/T2: 36% vs 21%; P<.01), less lymph node involvement (ypN1: 35% vs 59%; P<.01), and fewer positive resection margins (14% vs 21%; P=.01), but had more postoperative unplanned readmissions (9% vs 6%; P=.01) and increased 90-day mortality (7% vs 4%; P=.03). Those in the CRT group were also less likely to receive postoperative therapy (26% vs 51%; P<.01). Conclusions: Preoperative CT and CRT have similar OS, but CRT is associated with more favorable pathologic features at the cost of higher postoperative morbidity and mortality. Additional trials investigating preoperative therapy are needed for patients with resectable pancreatic cancer.

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U2 - 10.6004/jnccn.2018.7068

DO - 10.6004/jnccn.2018.7068

M3 - Article

VL - 16

SP - 1468

EP - 1475

JO - Journal of the National Comprehensive Cancer Network : JNCCN

JF - Journal of the National Comprehensive Cancer Network : JNCCN

SN - 1540-1405

IS - 12

ER -