Impact of Neoadjuvant Therapy in Resected Pancreatic Ductal Adenocarcinoma of the Pancreatic Body or Tail on Surgical and Oncological Outcome: A Propensity-Score Matched Multicenter Study

Abstract

Background. Several studies have suggested a survival benefit of neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma (PDAC) in the pancreatic head. Data concerning NAT for PDAC located in pancreatic body or tail are lacking. Methods. Post hoc analysis of an international multicenter retrospective cohort of distal pancreatectomy for PDAC in 34 centers from 11 countries (2007-2015). Patients who underwent resection after NAT were matched (1:1 ratio), using propensity scores based on baseline characteristics, to patients who underwent upfront resection. Median overall survival was compared using the stratified log-rank test. Results. Among 1236 patients, 136 (11.0%) received NAT, most frequently FOLFIRINOX (25.7%). In total, 94 patients receiving NAT were matched to 94 patients undergoing upfront resection. NAT was associated with less postoperative major morbidity (Clavien-Dindo C 3a, 10.6% vs. 23.4%, P = 0.020) and pancreatic fistula grade B/C (9.6% vs. 21.3%, P = 0.026). NAT did not improve overall survival [27 (95% CI 14-39) versus 31 months (95% CI 19-42), P = 0.277], as compared with upfront resection. In a sensitivity analysis of 251 patients with radiographic tumor involvement of splenic vessels, NAT Mohammed Abu Hilal and Marc G. Besselink share senior authorship.

Recurrence Patterns for Pancreatic Ductal Adenocarcinoma after Upfront Resection Versus Resection Following Neoadjuvant Therapy: A Comprehensive Meta-Analysis

“…Patients were commonly female (54%, 2885/5328) in their seventh decade of life (weighted mean age 62 years, CI 60.4–63.6). Tumour location was reported in 20 studies [ 6 , 7 , 8 , 26 , 29 , 37 , 38 , 39 , 40 , 41 , 42 , 44 , 45 , 47 , 48 , 49 , 50 , 51 , 53 , 54 ] and was predominantly the pancreatic head or neck (79%, 2478/3147) ( Table S1 ).…”

“…Adjuvant therapy was reported in 14 studies [ 7 , 25 , 26 , 27 , 28 , 37 , 41 , 42 , 44 , 45 , 47 , 48 , 51 , 52 ] and was received by 66% of patients (1649/2505). This included either chemotherapy (61%, 1011/1649) or chemoradiotherapy (39%, 638/1649).…”

“…Four studies [ 6 , 7 , 25 , 28 ] defined BRPC by the national cancer network guidelines [ 55 ]. The types of resection were reported in 17 studies [ 6 , 8 , 25 , 26 , 28 , 29 , 37 , 40 , 41 , 42 , 43 , 45 , 48 , 49 , 50 , 51 , 53 ]: pancreaticoduodenectomy (PD, including pylorus preserving variant, 79%, 2639/3344), distal pancreatectomy (17%, 564/3344), and total pancreatectomy (4%, 141/3344).…”

“…NAT was associated with a significantly longer weighted mean time to first recurrence (18.8 months, CI 14.5–23.5) compared to US (15.7months, CI 12.2–19.2) in nine studies [ 6 , 26 , 27 , 37 , 39 , 40 , 41 , 45 , 47 ] (OR 0.18 (CI 0.05–0.32), p = 0.015, Figure 5 B). Fewer than three studies reported resectability-specific time to first recurrence in both the US and NAT groups and no study reported organ-specific time to first recurrence.…”

“…Propensity score matched data was used in preference to raw unmatched data to improve homogeneity of the datasets in relevant studies [ 8 , 27 , 37 , 38 ]. However, if baseline characteristic data or outcome data were not reported for propensity score matching, the unmatched data was used [ 28 ].…”