Neoadjuvant therapy versus upfront surgery for resected pancreatic adenocarcinoma: A nationwide propensity score matched analysis

Background Neoadjuvant therapy is an emerging paradigm in pancreatic cancer care; however, its role for resectable disease remains controversial in the absence of conclusive randomized controlled trials. The purpose of the present study is to assess the impact of neoadjuvant therapy on survival in r...

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Bibliographic Details
Published in:Surgery 2017-03, Vol.161 (3), p.592-601
Main Authors: de Geus, Susanna W.L., BS, Eskander, Mariam F., MD, MPH, Bliss, Lindsay A., MD, MPH, Kasumova, Gyulnara G., MD, Ng, Sing Chau, MS, Callery, Mark P., MD, Tseng, Jennifer F., MD, MPH
Format: Article
Language:English
Subjects:
Adenocarcinoma - mortality
Adenocarcinoma - pathology
Adenocarcinoma - therapy
Aged
Antineoplastic Agents - therapeutic use
Chemotherapy, Adjuvant
Female
Humans
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Pancreatectomy
Pancreatic Neoplasms - mortality
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - therapy
Propensity Score
Retrospective Studies
Surgery
Survival Rate
Treatment Outcome
United States
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Summary:Background Neoadjuvant therapy is an emerging paradigm in pancreatic cancer care; however, its role for resectable disease remains controversial in the absence of conclusive randomized controlled trials. The purpose of the present study is to assess the impact of neoadjuvant therapy on survival in resected pancreatic cancer patients by clinical stage. Methods A retrospective cohort study using the National Cancer Data Base from 2004 to 2012 including nonmetastatic pancreatic adenocarcinoma patients who underwent pancreatectomy and initiated chemotherapy. Propensity score matching within each stage was used to account for potential selection bias between patients undergoing neoadjuvant therapy and upfront surgery. Overall survival was compared by the Kaplan-Meier method. Results In the study, 1,541 and 7,159 patients received neoadjuvant therapy followed by surgery and upfront surgery succeeded by adjuvant therapy, respectively. In clinical stage III pancreatic cancer ( n  = 486), neoadjuvant therapy was associated with significant survival benefit after matching (median survival 22.9 vs 17.3 months; log-rank P  
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2016.08.040