Akhil Chawla1, George Molina2, Linda M Pak2, Michael Rosenthal3,4, Joseph D Mancias3,5, Thomas E Clancy2,3, Brian M Wolpin3,6, Jiping Wang7,8. 1. Division of Surgical Oncology, Department of Surgery, Northwestern Medicine Regional Medical Group, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 2. Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 3. Dana Farber/Brigham and Women Cancer Center, Boston, MA, USA. 4. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 5. Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 6. Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. 7. Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. jwang39@bwh.harvard.edu. 8. Dana Farber/Brigham and Women Cancer Center, Boston, MA, USA. jwang39@bwh.harvard.edu.
Abstract
BACKGROUND: Neoadjuvant therapy has shown value in various cancer types. The role of neoadjuvant therapy in pancreatic ductal adenocarcinoma (PDAC), however, remains unknown. The aim of the present work is to evaluate the effect of neoadjuvant therapy on the survival of patients with borderline-resectable PDAC. PATIENTS AND METHODS: Between 2004 and 2015, 7730 patients with resectable PDAC and 1980 patients with borderline-resectable PDAC were identified from the National Cancer Database (NCDB). Survival was compared between resectable and borderline-resectable patients. Survival and pathologic characteristics were also compared within borderline-resectable patients who received neoadjuvant therapy and those who received adjuvant therapy alone. Kaplan-Meier method and Cox proportional-hazard models were used for analysis. RESULTS: Median overall survival (mOS) of all patients with resectable PDAC was similar to that of patients with borderline-resectable disease treated with neoadjuvant therapy (26.5 versus 25.7 months, p = 0.78). Patients with borderline-resectable disease treated with neoadjuvant therapy had improved mOS compared with borderline-resectable patients treated with adjuvant therapy alone (25.7 versus 19.6 months, p < 0.0001). When comparing patients with borderline-resectable disease who received neoadjuvant therapy versus those who received adjuvant therapy alone, the former less often had node-positive pancreatic cancer (40.6% versus 76.3%, p < 0.001) and margin-positive resections (17.8% versus 44.4%, p < 0.001). CONCLUSION: Neoadjuvant therapy is associated with enhanced survival in patients with borderline-resectable pancreatic cancer, which may be attributed to tumor downstaging.
BACKGROUND: Neoadjuvant therapy has shown value in various cancer types. The role of neoadjuvant therapy in pancreatic ductal adenocarcinoma (PDAC), however, remains unknown. The aim of the present work is to evaluate the effect of neoadjuvant therapy on the survival of patients with borderline-resectable PDAC. PATIENTS AND METHODS: Between 2004 and 2015, 7730 patients with resectable PDAC and 1980 patients with borderline-resectable PDAC were identified from the National Cancer Database (NCDB). Survival was compared between resectable and borderline-resectable patients. Survival and pathologic characteristics were also compared within borderline-resectable patients who received neoadjuvant therapy and those who received adjuvant therapy alone. Kaplan-Meier method and Cox proportional-hazard models were used for analysis. RESULTS: Median overall survival (mOS) of all patients with resectable PDAC was similar to that of patients with borderline-resectable disease treated with neoadjuvant therapy (26.5 versus 25.7 months, p = 0.78). Patients with borderline-resectable disease treated with neoadjuvant therapy had improved mOS compared with borderline-resectable patients treated with adjuvant therapy alone (25.7 versus 19.6 months, p < 0.0001). When comparing patients with borderline-resectable disease who received neoadjuvant therapy versus those who received adjuvant therapy alone, the former less often had node-positive pancreatic cancer (40.6% versus 76.3%, p < 0.001) and margin-positive resections (17.8% versus 44.4%, p < 0.001). CONCLUSION: Neoadjuvant therapy is associated with enhanced survival in patients with borderline-resectable pancreatic cancer, which may be attributed to tumor downstaging.
Authors: Adam Ofri; Danika Zuidersma; Connie I Diakos; Amanda Stevanovic; Matthew Wong; Samriti Sood; Jaswinder S Samra; Anthony J Gill; Anubhav Mittal Journal: Front Surg Date: 2022-06-24
Authors: Marco Vivarelli; Federico Mocchegiani; Daniele Nicolini; Andrea Vecchi; Grazia Conte; Enrico Dalla Bona; Roberta Rossi; Andrea Benedetti Cacciaguerra Journal: Front Oncol Date: 2022-05-30 Impact factor: 5.738
Authors: Zarrukh Baig; Nawaf Abu-Omar; Rayyan Khan; Carlos Verdiales; Ryan Frehlick; John Shaw; Fang-Xiang Wu; Yigang Luo Journal: Technol Cancer Res Treat Date: 2021 Jan-Dec