A Catch-22: Neoadjuvant Therapy Without Postoperative Therapy for Early-Stage Pancreatic Cancer
Susanna W.L. de Geus, Marianna V. Papageorge, Alison P. Woods, Sing Chau Ng, David McAneny, Jennifer F. Tseng, Teviah E. Sachs
Boston Medical Center, Boston, MA
Background: There is growing consensus regarding the need for additional postoperative therapy in patients who underwent neoadjuvant therapy (NAT) for pancreatic cancer. However, often patients fail to receive additional treatment. The purpose of this study is to compare survival for patients who received NAC without the adjuvant therapy component to those with upfront surgery (UFS) followed by adjuvant therapy.
Methods: Patients with clinical stage I-IIa pancreatic adenocarcinoma who underwent pancreatectomy and chemotherapy with or without radiation were identified from the NCDB. Three cohorts were created: NAT without postoperative therapy, UFS followed by adjuvant therapy, and NAT with postoperative therapy. Propensity-score matching was used to adjust for selection bias. Landmark analysis at 6 months was performed to control for immortal time bias.
Results: In total, 8,830 patients were identified; 16.3% underwent NAT without postoperative therapy, 74.7% UFS followed by adjuvant therapy, and 9.0% NAT followed by postoperative therapy. After matching, median survival for patients who underwent NAT followed by postoperative therapy was superior to patients who underwent UFS followed by adjuvant therapy (30.0 vs. 25.1 months; p=0.0013). Median survival for patients who underwent NAT without postoperative therapy and patients who underwent UFS followed by adjuvant therapy was similar after matching (24.1 vs. 24.1 months; p=0.9915).
Conclusions: In early-stage pancreatic cancer NAT is only associated with superior survival if patients are able to receive additional postoperative therapy.
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