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Adjuvant chemotherapy versus observation following neoadjuvant therapy and surgery for resectable stages I–II pancreatic cancer

Published online by Cambridge University Press:  14 April 2021

Sung Jun Ma ,
Lucas M. Serra ,
Austin J. Bartl ,
Hye Ri Han ,
Fatemeh Fekrmandi ,
Austin J. Iovoli ,
Gregory M. Hermann ,
Han Yu  and
Anurag K. Singh Open the ORCID record for Anurag K. Singh [Opens in a new window]
Sung Jun Ma
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY14203, USA
Lucas M. Serra
Affiliation:
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY14203, USA
Austin J. Bartl
Affiliation:
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY14203, USA
Hye Ri Han
Affiliation:
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY14203, USA
Fatemeh Fekrmandi
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY14203, USA
Austin J. Iovoli
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY14203, USA
Gregory M. Hermann
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY14203, USA
Han Yu
Affiliation:
Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY14203, USA
Anurag K. Singh*
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY14203, USA
*
Author for correspondence: Anurag K. Singh, MD, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY14203, USA. Tel: 716-845-5715. Fax: 716-845-7616. E-mail: Anurag.Singh@RoswellPark.org
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Abstract

Aim:

This National Cancer Database (NCDB) analysis was performed to evaluate the outcomes of adjuvant chemotherapy (AC) versus observation for resected pancreatic adenocarcinoma treated with neoadjuvant therapy (NT).

Materials and methods:

The NCDB was queried for primary stages I–II cT1-3N0-1M0 resected pancreatic adenocarcinoma treated with NT (2004–2015). Baseline patient, tumour and treatment characteristics were extracted. The primary end point was overall survival (OS). With a 6-month conditional landmark, Kaplan–Meier analysis, multivariable Cox proportional hazards method and 1:1 propensity score matching was used to analyse the data.

Results:

A total of 1,737 eligible patients were identified, of which 1,247 underwent post-operative observation compared to 490 with AC. The overall median follow-up was 34·7 months. The addition of AC showed improved survival on the multivariate analysis (HR 0·78, p < 0·001). AC remained statistically significant for improved OS, with a median OS of 26·3 months versus 22·3 months and 2-year OS of 63·9% versus 52·9% for the observation cohort (p < 0·001). Treatment interaction analysis showed OS benefit of AC for patients with smaller tumours.

Findings:

Our findings suggest a survival benefit for AC compared to observation following NT and surgery for resectable pancreatic adenocarcinoma, especially in patients with smaller tumours.

Keywords

NCDBoverall survivalpancreatic cancerpost-operative chemotherapytrimodality therapy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 3 , September 2022 , pp. 383 - 392
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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