Role of adjuvant therapy in resected stage IA subcentimeter (T1a/T1b) pancreatic cancer

Abstract

Objectives: Standard of care treatment for resected stage I-III pancreatic ductal adenocarcinoma (PDAC) is adjuvant gemcitabine-based chemotherapy. The role of adjuvant treatment for sub-centimeter, stage IA PDAC is unknown. This study evaluated the effect of adjuvant treatment on survival outcomes of stage IA (T1N0), resected PDAC using the National Cancer Database (NCDB). Methods: Retrospective review of the NCDB was conducted for T1 (tumor limited to pancreas, ≤2 cm in greatest dimension), node negative (N0), resected PDAC between 2004 and 2013. Patient demographics, histology, adjuvant treatment, and survival trends were examined. Kaplan-Meier analysis and log-rank tests were performed to determine unadjusted association between overall survival (OS), tumor size, and treatment. Results: A total of 876 patients met the inclusion criteria: mean age 66.2 (32–90) years; 83.3% Caucasian (N=730); 53.1% female (N=465); 45.9% moderately differentiated tumor histology (N=402); 70.0% (N=613) tumors 1–2 cm (T1c); 30.0% (N=263) <1 cm (T1a/T1b); 94.2% negative surgical margins (N=815); 46.9% (N=410) received adjuvant therapy. Median OS was significantly different for patients who received adjuvant therapy compared to patients who did not (70.7 vs. 46.9 months; P=0.0001). For patients with <1 cm tumors, survival was not significantly different between patients who received adjuvant treatment compared to those who did not (not reached vs. 85.3 months; P=0.54). In the multivariable analysis, none of the covariates (treatment group, Charlson-Deyo score, age, insurance, facility status) showed significant difference for patients with <1 cm tumors. Conclusion: This is the first report showing no survival benefit of adjuvant therapy in resected sub-centimeter PDAC.

Pathologic T1 and T2 encapsulated invasive carcinomas arising from mucinous cystic neoplasms of the pancreas have favorable prognosis and might be treated conservatively

“…The current recommendation is that MCN‐AIC patients follow the standardized chemotherapy‐based management applied in treating conventional pancreatic cancer [ 30 , 31 ]. Recently, a retrospective analysis suggested that, for early‐stage PDAC patients with carcinoma measuring <1 cm (T1a/T1b), survival is not significantly different between patients who received adjuvant treatment and those who did not [ 32 ]. As for MCN‐AICs, Hui et al [ 4 ] presented three well‐documented T1a/T1b MCN‐AICs with favorable prognosis and advocated for regular follow‐up to reduce the use of systemic chemotherapy.…”

Stage IA Patients With Pancreatic Ductal Adenocarcinoma Cannot Benefit From Chemotherapy: A Propensity Score Matching Study

“…According to the 7th edition AJCC staging manual, Ostapoff et al (25) showed that adjuvant chemotherapy was associated with better OS outcomes for stage I PDAC (including stage IA and IB) using the National Cancer Data Base (NCDB). Also using the NCDB, however, Shaib et al (26) further reported that adjuvant chemotherapy did not improve the prognosis for stage I sub-centimeter PDAC (<1 cm in greatest dimension). Although the classification methods in our study varied from the previous studies, these results indicated that early-stage PDAC patients may not benefit from adjuvant chemotherapy.…”

Assessment of Standardization Circumferential Resection Margin Status Influence Survival following Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

“…Postoperatively, however, less than 50% of patients received adjuvant chemotherapy [38] . In a retrospective study of PDAC, Shaib W.L et al had reported that the adjuvant chemotherapy could prolong survival time [39] . In the same study, Nagrial A.M et al had reported that the elder PDAC patients who had received postoperative adjuvant chemotherapy could live longer [40] .…”