Neoadjuvant chemotherapy is associated with improved survival in patients with left‐sided pancreatic adenocarcinoma

Abstract

Background: Neoadjuvant chemotherapy is used infrequently in the management of distal pancreatic cancers. We investigated outcomes associated with neoadjuvant chemotherapy or up-front surgery in patients undergoing distal pancreatectomy. Methods: The National Cancer Database (2004-2016) was queried for patients with pancreas cancer who underwent distal pancreatectomy. Demographics, clinical characteristics, postoperative outcomes, pathologic outcomes, and overall survival were analyzed by univariate and multivariate analysis. Results: Six thousand five-hundred and twenty-three patients were included, including 5,643 who underwent up-front distal pancreatectomy and 880 who received neoadjuvant therapy. Factors associated with receipt of neoadjuvant chemotherapy included care at academic/research programs, higher education level, higher clinical T stage, higher clinical N stage, and elevated carbohydrate antigen 19-9 level. Patients who received neoadjuvant therapy had fewer positive lymph nodes, higher margin-negative resection rate, lower 30-day readmission rate, and lower 90-day mortality rate. Patients who received neoadjuvant therapy had longer median overall survival (28.8 vs 22.0 months; P < .001). On multivariate analysis, neoadjuvant therapy remained independently associated with improved survival (hazards ratio, 0.72; 95% confidence inteval, 0.63-0.82; P < .001). Conclusions: Neoadjuvant therapy in patients with left-sided pancreatic cancers is associated with improved pathologic outcomes as well as longer overall survival. Neoadjuvant therapy should be considered in all patients with PDAC regardless of tumor location.

Neoadjuvant Treatment Strategies in Resectable Pancreatic Cancer

“…Focusing on the tumor location, Ocuin et al reported from the US National Cancer Database that in 6523 patients undergoing distal pancreatectomy, those who received neoadjuvant chemotherapy had a longer median OS (28.8 vs. 22.0 months; p < 0.001). However, multiagent neoadjuvant chemotherapy regimens were associated with improved OS compared with multiagent adjuvant regimens (30.2 vs. 23.1 months; p < 0.001), whereas single-agent regimens were not associated with a survival benefit [ 52 ]. To date, there are no data suggesting that pancreatic tumor location should be a consideration in the decision of whether to give neoadjuvant chemotherapy.…”

Potential of combination of DCE-MRI and DWI with serum CA125 and CA199 in evaluating effectiveness of neoadjuvant chemotherapy in breast cancer

“…Neoadjuvant chemotherapy refers to systemic chemotherapy before surgical resection or local radiotherapy on the lesions. It reduces the risk of cancer cell metastasis to a certain extent, thereby facilitating follow-up intervention to control the disease conditions of the patients [ 4 – 6 ]. Based on years of clinical experience, neoadjuvant chemotherapy is often used in clinical intervention in patients with tumours [ 7 – 9 ].…”