Neoadjuvant therapy followed by resection versus upfront resection for resectable pancreatic cancer: A propensity score matched analysis

Ali A. Mokdad, Rebecca M. Minter, Hong Zhu, Mathew M. Augustine, Matthew R. Porembka, Sam C. Wang, Adam C. Yopp, John C. Mansour, Michael A. Choti, Patricio M. Polanco

Research output: Contribution to journalArticlepeer-review

257 Scopus citations

Abstract

Purpose To compare overall survival between patients who received neoadjuvant therapy (NAT) followed by resection and those who received upfront resection (UR)-as well as a subgroup of UR patients who also received adjuvant therapy-for early-stage resectable pancreatic adenocarcinoma. Patients and Methods Adult patients with resected, clinical stage I or II adenocarcinoma of the head of the pancreas were identified in the National Cancer Database from 2006 to 2012. Patients who underwent NAT followed by curative-intent resection were matched by propensity score with patients whose tumors were resected upfront. Overall survival was compared by using a Cox proportional hazards regression model. Early postoperative and oncologic outcomes were evaluated. Results We identified 15,237 patients with clinical stage I or II resected pancreatic head adenocarcinoma. From the NAT group, 2,005 patients (95%) were matched with 6,015 patients who underwent UR. The NAT group was associated with improved survival compared with UR (median survival, 26 months v 21 months, respectively; stratified log-rank P , .01; hazard ratio, 0.72; 95% CI, 0.68 to 0.78). Patients in the UR group had higher pathologic T stage (pT3 and T4: 86% v 73%; P , .01), higher positive lymph nodes (73% v 48%; P , .01), and higher positive resection margin (24% v 17%; P , .01). Compared with a subset of UR patients who received adjuvant therapy, NAT patients had a better survival (adjusted hazard ratio, 0.83; 95% CI, 0.73 to 0.89). Conclusion NAT followed by resection has a significant survival benefit compared with UR in early-stage, resected pancreatic head adenocarcinoma. These findings support the use of NAT, particularly as a patient selection tool, in the management of resectable pancreatic adenocarcinoma.

Original languageEnglish (US)
Pages (from-to)515-522
Number of pages8
JournalJournal of Clinical Oncology
Volume35
Issue number5
DOIs
StatePublished - Feb 10 2017

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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