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Neoadjuvant Chemotherapy for Pancreatic Adenocarcinoma Lessens the Deleterious Effect of Omission of Adjuvant Chemotherapy

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Despite controversy regarding the role of neoadjuvant chemotherapy (NAC) in pancreatic adenocarcinoma, nearly half of resected patients do not receive chemotherapy postoperatively. This study aimed to examine whether use of NAC compensates for omission of adjuvant chemotherapy (AC) for resected pancreatic adenocarcinoma.

Methods

Adults with resected stages 1 to 3 pancreatic adenocarcinoma were enrolled from the National Cancer Database NCDB (2006–2016). Overall survival (OS) analyses were used to examine the impact of NAC on those who did not receive AC.

Results

The study analyzed a national cohort of 56,286 patients: 30% without chemotherapy, 11% with NAC, 54% with AC, and 5% with NAC plus AC. Use of NAC increased by more than 400% from 2006 to 2016, whereas the rates for omission of chemotherapy remained unchanged. The OS rates were similar between the patients who received NAC and those who received AC (hazard ratio, 0.97; p = 0.21). Among the patients who did not receive AC, NAC was associated with improved OS (26.7 vs. 18.4 months; p < 0.0001). The patients who did not receive AC but underwent NAC had a median OS comparable with the OS of those who received AC alone (26.9 vs. 24.7 months). In the adjusted analysis, the use of NAC for those without AC was significantly associated with improved OS (estimate, − 0.24; p < 0.0001).

Conclusions

Although data are limited regarding the survival benefit derived from neoadjuvant versus adjuvant chemotherapy in pancreatic adenocarcinoma, nearly half of patients do not receive adjuvant chemotherapy. This study demonstrates that the use of NAC lessens the survival disadvantage caused by omission of AC. Despite controversy, NAC may be considered for pancreatic adenocarcinoma patients given the high likelihood that adjuvant chemotherapy will be omitted.

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Authors and Affiliations

  1. Division Hepatobiliary and Pancreatic Surgery, University of California, San Francisco, San Francisco, CA, USA

    Mohamed Abdelgadir Adam MD

  2. Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Ibrahim Nassour MD, Richard Hoehn MD, David L. Bartlett MD, Kenneth K. W. Lee MD, Amer H. Zureikat MD & Alessandro Paniccia MD

  3. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Callie A. Hlavin MD & Kenneth K. W. Lee MD

  4. Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Nathan Bahary MD

Authors
  1. Mohamed Abdelgadir Adam MD
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  2. Ibrahim Nassour MD
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  3. Richard Hoehn MD
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  4. Callie A. Hlavin MD
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  5. Nathan Bahary MD
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  6. David L. Bartlett MD
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  7. Kenneth K. W. Lee MD
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  8. Amer H. Zureikat MD
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  9. Alessandro Paniccia MD
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Correspondence to Alessandro Paniccia MD.

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Adam, M.A., Nassour, I., Hoehn, R. et al. Neoadjuvant Chemotherapy for Pancreatic Adenocarcinoma Lessens the Deleterious Effect of Omission of Adjuvant Chemotherapy. Ann Surg Oncol 28, 3800–3807 (2021). https://doi.org/10.1245/s10434-020-09446-x

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  • DOI: https://doi.org/10.1245/s10434-020-09446-x

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