Optimal Management of Resectable Pancreatic Head Cancer in the Elderly Patient: Does Neoadjuvant Therapy Offer a Survival Benefit?

Autor: Rieser CJ; Division of GI Surgical Oncology, Department of Surgery, Pancreatic Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA., Zenati M; Department of Surgery and Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA., Narayanan S; Division of GI Surgical Oncology, Department of Surgery, Pancreatic Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA., Bahary N; Department of Medical Oncology, University of Pittsburgh, Pittsburgh, PA, USA., Lee KK; Division of GI Surgical Oncology, Department of Surgery, Pancreatic Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA., Paniccia A; Division of GI Surgical Oncology, Department of Surgery, Pancreatic Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA., Bartlett DL; AHN Cancer Institute, Allegheny Health Network, Pittsburgh, PA, USA., Zureikat AH; Division of GI Surgical Oncology, Department of Surgery, Pancreatic Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA. zureikatah@upmc.edu.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2021 Oct; Vol. 28 (11), pp. 6264-6272. Date of Electronic Publication: 2021 Mar 21.
DOI: 10.1245/s10434-021-09822-1
Abstrakt: Introduction: Neoadjuvant therapy (NAT) is a growing strategy for patients with resectable pancreatic ductal adenocarcinoma (PDAC). Elderly patients are at increased risk of treatment withdrawal due to functional decline, and the benefit of NAT in this cohort remains to be studied.
Objective: The objective of this study was to compare outcomes of elderly patients with resectable head PDAC who underwent NAT or a surgery-first (SF) approach.
Methods: All patients 75 years of age and older with radiographically resectable (National Comprehensive Cancer Network criteria) PDAC who underwent pancreaticoduodenectomy at a single institution from 2008 to 2017 were analyzed. Baseline characteristics and perioperative outcomes were compared between the SF and NAT cohorts. Recurrence-free survival and overall survival (OS) were analyzed by treatment strategy.
Results: Overall, 158 patients were identified: SF cohort = 90 (57%) and NAT cohort = 68 (43%). Patients in the SF cohort were older (80 vs. 78 years; p = 0.01) but there were no differences in preoperative comorbidities or frailty indices. SF patients had a trend toward higher rates of major complications (38% vs. 24%; p = 0.06) with higher Comprehensive Complication Index totals (20.9 vs. 20; p = 0.03). There were similar rates of adjuvant therapy. NAT was associated with significantly longer OS (24.6 vs. 17.6 months; p = 0.01) in both the intent-to-treat and resected cohorts. On multivariable analysis (MVA), NAT remained an independent predictor of OS (hazard ratio 0.60; p = 0.02).
Conclusion: NAT is safe and effective for elderly patients with PDAC. This study suggests NAT is associated with fewer complications after surgery, equal rates of adjuvant therapy receipt, and increased OS over a surgery-first approach.
(© 2021. Society of Surgical Oncology.)
Databáze: MEDLINE
Externí odkaz: