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J Gastrointest Surg. 2018 Feb;22(2):214-225. doi: 10.1007/s11605-017-3541-8. Epub 2017 Oct 4.

Is Neoadjuvant Therapy Sufficient in Resected Pancreatic Cancer Patients? A National Study.

Author information

1
Surgical Outcomes Analysis and Research (SOAR), Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Rd, Palmer 6, Boston, MA, 02215, USA.
2
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
3
Surgical Outcomes Analysis and Research (SOAR), Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Rd, Palmer 6, Boston, MA, 02215, USA. jftseng@bidmc.harvard.edu.

Abstract

BACKGROUND:

Despite the increasing use of neoadjuvant treatment, the question of whether preoperatively treated, successfully resected patients should receive additional postoperative adjuvant treatment remains unanswered. We evaluate the impact of adjuvant therapy following neoadjuvant treatment and pancreatectomy in pancreatic cancer patients in a large national study.

METHODS:

We used the National Cancer Data Base between 2006 and 2013 to identify resected, non-metastatic pancreatic adenocarcinoma patients who received neoadjuvant chemo(radio)therapy followed by pancreatectomy. Kaplan-Meier and multivariate Cox proportional hazard regression analyses were performed to compare survival between groups.

RESULTS:

In total, 1357 patients were identified. Of the patients, 38.6% (n = 524) were treated with postoperative therapy. There was no difference in unadjusted median overall survival between patients who did and did not receive postoperative therapy (median survival, 27.5 vs. 27.1 months, log-rank p = 0.5409). Postoperative therapy was not significantly associated with favorable prognosis in patients with positive resection margins (log-rank p = 0.6452) or positive lymph nodes (log-rank p = 0.6252). On multivariate analysis, receipt of postoperative therapy was not predictive of survival (hazard ratio 0.972; 95% CI 0.848-1.115; p = 0.6876).

CONCLUSIONS:

Our results using national data suggest that after receipt of neoadjuvant therapy and pancreatectomy, additional postoperative therapy may not provide additional survival benefit. These data warrant further prospective data collection and consideration for clinical trials.

KEYWORDS:

Adjuvant chemotherapy; Neoadjuvant therapy; Pancreatic neoplasms; Survival

PMID:
29235000
DOI:
10.1007/s11605-017-3541-8
[Indexed for MEDLINE]

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