The benefit of adjuvant chemotherapy following pancreaticoduodenectomy for pancreatic adenocarcinoma depends on response to neoadjuvant therapy

• Published in: Journal of surgical oncology Vol. 130; no. 1; pp. 109 - 116
• Main Authors: Carpenter, Elizabeth L., Van Decar, Spencer G., McCarthy, Patrick M., Valdera, Franklin A., Adams, Alexandra M., O'Shea, Anne E., Smolinsky, Todd, Thomas, Katryna, Clifton, Guy T., Newhook, Timothy E., Peoples, George E., Nelson, Daniel W., Vreeland, Timothy J.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.07.2024
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adenocarcinoma - therapy; adjuvant therapy; Aged; Cancer therapies; Carcinoma, Pancreatic Ductal - drug therapy; Carcinoma, Pancreatic Ductal - mortality; Carcinoma, Pancreatic Ductal - pathology; Carcinoma, Pancreatic Ductal - surgery; Carcinoma, Pancreatic Ductal - therapy; chemotherapy; Chemotherapy, Adjuvant; Female; Follow-Up Studies; Humans; Male; Middle Aged; neoadjuvant therapy; Neoadjuvant Therapy - mortality; Pancreatic cancer; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pancreatic Neoplasms - therapy; Pancreaticoduodenectomy; Prognosis; Retrospective Studies; Survival Rate; adjuvant therapy; pancreatic cancer; chemotherapy; neoadjuvant therapy
• ISSN: 0022-4790; 1096-9098; 1096-9098
• DOI: 10.1002/jso.27689

Background The benefit of adjuvant therapy (AT) remains unclear in pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant therapy (NAT) and surgical resection. Methods The 2019 National Cancer Database was queried for patients with non‐metastatic PDAC who received NAT followed by pancreaticoduodenectomy. Only patients with data regarding receipt of AT were included. Patients were classified if they had nodal down‐staging specifically, or any downstaging (Tumor, Nodal, or overall). Propensity score matching (PSM) adjusted for pretreatment covariate imbalance between groups. The weighted Kaplan–Meier method and log‐rank test were used to estimate the cumulative survival. Results After exclusion criteria and PSM, a total of 2784 patients remained; 1689 (60.7%) received AT and 1095 (39.3%) did not receive AT. Among all, those with additional AT had a significantly improved overall survival (OS) (p < 0.001). Upon evaluation of patients without downstaging after NAT, those who received AT had improved OS (no nodal downstaging or any downstaging; p = 0.002; p = 0.001). When evaluating patients with downstaging after NAT, those receiving AT did not have improved OS (nodal downstaging or any downstaging: p = 0.352; p = 0.99). Conclusion Response to NAT appears to correlate with the benefit of AT following pancreaticoduodenectomy; patients who have a favorable response to NAT may not benefit from AT.