Who could complete and benefit from the adjuvant chemotherapy regarding pancreatic ductal adenocarcinoma? A multivariate‐adjusted analysis at the pre‐adjuvant chemotherapy timing

Fu, Ningzhen; Li, Jingfeng; Jin, Jiabin; Yu, Jiang; Deng, Xiaxing; Shen, Baiyong

doi:10.1002/cam4.4698

Cited by 4 publications

(1 citation statement)

References 47 publications

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“… 13 , 15 , 16 , 18 , 20 , 22 – 24 , 29 Few studies found that early initiation (definition ranging from 5 to 10 weeks) was associated with an improved survival, 17 , 21 , 26 – 28 whereas one study found that initiation after approximately 5 weeks conferred a survival benefit. 25 In most studies, the magnitude of the differences was small and of limited clinical relevance; however, the studies were prone to immortal time bias and selection bias. Immortal time bias can be introduced when information on future treatments are used to create exposure groups at baseline.…”

Section: Discussionmentioning

confidence: 99%

Impact on Survival of Early Versus Late Initiation of Adjuvant Chemotherapy After Pancreatic Adenocarcinoma Surgery: A Target Trial Emulation

Kirkegård,

Ladekarl,

Lund

et al. 2023

Ann Surg Oncol

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Background We examined the impact of early (0–4 weeks after discharge) versus late (> 4–8 weeks after discharge) initiation of adjuvant chemotherapy on pancreatic adenocarcinoma survival. Methods We used Danish population-based healthcare registries to emulate a hypothetical target trial using the clone-censor-weight approach. All eligible patients were cloned with one clone assigned to ‘early initiation’ and one clone assigned to ‘late initiation’. Clones were censored when the assigned treatment was no longer compatible with the actual treatment. Informative censoring was addressed using inverse probability of censoring weighting. Results We included 1491 patients in a hypothetical target trial, of whom 32.3% initiated chemotherapy within 0–4 weeks and 38.3% between > 4 and 8 weeks after discharge for pancreatic adenocarcinoma surgery; 206 (13.8%) initiated chemotherapy after > 8 weeks, and 232 (15.6%) did not initiate chemotherapy. Median overall survival was 30.4 and 29.9 months in late and early initiators, respectively. The absolute differences in OS, comparing late with early initiators, were 3.2% (95% confidence interval [CI] − 1.5%, 7.9%), − 0.7% (95% CI − 7.2%, 5.8%), and 3.2% (95% CI − 2.8%, 9.3%) at 1, 3, and 5 years, respectively. Late initiators had a higher increase in albumin levels as well as higher pretreatment albumin values. Conclusions Postponement of adjuvant chemotherapy up to 8 weeks after discharge from pancreatic adenocarcinoma surgery is safe and may allow more patients to receive adjuvant therapy due to better recovery.

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