Total neoadjuvant therapy is associated with improved overall survival and pathologic response in pancreatic adenocarcinoma. Issue 3 (27th April 2022)

• Record Type: Journal Article
• Authors: Villano, Anthony M.; O'Halloran, Eileen; Goel, Neha; Ruth, Karen; Barrak, Dany; Lefton, Max; Reddy, Sanjay S.
• Is Part Of: Journal of surgical oncology. Volume 126:Issue 3(2022)
• Page Start: 502
• Page End: 512
• Publication Date: 2022-04-27
• Subjects: cancer -- neoadjuvant -- outcomes -- pancreas -- survival; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.26906
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract: Background: Few studies have evaluated outcomes of total neoadjuvant therapy (TNT) compared with single modality neoadjuvant therapy (SMNT) or surgery first (SF) for pancreatic ductal adenocarcinoma (PDAC). Methods: A single‐institution retrospective review of PDAC patients who underwent pancreatectomy was conducted (1993–2019). Overall survival (OS) estimates from diagnosis and from surgery were determined using Kaplan–Meier methods; Cox proportional hazards models adjusted for covariates. Results: Surgery was performed upfront (SF) in 168 (46.9%), while 111 (31.0%) had chemotherapy or chemoradiation before resection (SMNT), and 79 (22.1%) underwent TNT (chemotherapy and chemoradiation). Resection margins were more frequently R0 in the TNT group (86.1%) compared with SMNT (64.0%) and SF (72%) ( p < 0.001). Complete pathologic response was more common in the TNT group (10.1%) compared with SMNT (3.6%) or SF (0.6%) ( p = 0.001), resulting in prolonged survival (median OS = 100.2 months). TNT patients demonstrated longer median OS from surgery (33.6 months) compared with SF (19.1 months) and SMNT (17.4 months) ( p = 0.010), which persisted after controlling for covariates. Conclusions: TNT is associated with more frequent complete pathologic response, a higher rate of margin negative resection, and prolonged OS as compared with SF or SMNT. Additional studies to identify subgroups that derive the greatest benefit are warranted.