Feasibility, Safety, and Efficacy of Aggressive Multimodal Management of Elderly Patients With Pancreatic Ductal Adenocarcinoma.

Autor:	Qiao G; Department of Surgery, Massachusetts General Hospital, Boston, MA., Fong ZV; Department of Surgery, Massachusetts General Hospital, Boston, MA., Bolm L; Department of Surgery, University Medical Center Schleswig-Holstein, Lubeck, Germany., Fernandez Del-Castillo C; Department of Surgery, Massachusetts General Hospital, Boston, MA., Ferrone CR; Department of Surgery, Massachusetts General Hospital, Boston, MA., Servin-Rojas M; Department of Surgery, Massachusetts General Hospital, Boston, MA., Pathak P; Department of Medicine, Massachusetts General Hospital, Boston, MA., Lau-Min K; Department of Medicine, Massachusetts General Hospital, Boston, MA., Allen JN; Department of Medicine, Massachusetts General Hospital, Boston, MA., Blaszkowsky LS; Department of Medicine, Massachusetts General Hospital, Boston, MA., Clark JW; Department of Medicine, Massachusetts General Hospital, Boston, MA., Parikh AR; Department of Medicine, Massachusetts General Hospital, Boston, MA., Ryan DP; Department of Medicine, Massachusetts General Hospital, Boston, MA., Weekes CD; Department of Medicine, Massachusetts General Hospital, Boston, MA., Roberts HM; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA., Wo JY; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA., Hong TS; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA., Lillemoe KD; Department of Surgery, Massachusetts General Hospital, Boston, MA., Qadan M; Department of Surgery, Massachusetts General Hospital, Boston, MA.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Jul 01; Vol. 280 (1), pp. 118-125. Date of Electronic Publication: 2023 Oct 13.
DOI:	10.1097/SLA.0000000000006131
Abstrakt:	Objective: To evaluate the safety and efficacy of neoadjuvant therapy (NAT), followed by surgical resection in patients with pancreatic ductal adenocarcinoma (PDAC) aged ≥75 years. Background: Whether administration of NAT, followed by surgical resection in elderly patients with PDAC is safe and effective is unknown. Methods: The present study is a three-part comparison of older (≥75 years) versus younger (<75 years) patients in different settings throughout the continuum of PDAC care. The first analysis was a comparison of older versus younger consecutive patients with nonmetastatic PDAC who were initiated on FOLFIRINOX. The second was a comparison of older versus younger patients who underwent NAT, followed by surgical resection, and the third and final analysis was a comparison of older patients who underwent either NAT, followed by surgical resection versus upfront surgical resection. Postoperative complications, overall survival (OS), and time to recurrence (TTR) were compared. Propensity score matching (PSM) analysis was performed to adjust for potential confounders. Results: In the first analysis, a lower proportion of older patients (n = 40) were able to complete the intended neoadjuvant FOLFIRINOX (8) cycles compared with younger patients (n = 214; 65.0% vs 81.4%, P = 0.021). However, older patients were just as likely to undergo surgical exploration as younger patients (77.5% vs 78.5%, P = 0.89), as well as surgical resection (57.5% vs 55.6%, P = 0.70). In the second analysis, PSM was conducted to compare older (n = 54) versus younger patients (n = 54) who underwent NAT, followed by surgical resection. There were no significant differences in postoperative complications between the matched groups. While there was a significant difference in OS between older and younger patients (median OS: 16.43 vs 30.83 months, P = 0.002), importantly, there was no significant difference in TTR (median: 7.65 vs 11.83 months, P = 0.215). In the third analysis, older patients who underwent NAT, followed by surgical resection (n = 48) were compared with similar older patients who underwent upfront surgical resection (n = 48). After PSM, there was a significant difference in OS (median OS: 15.78 months vs 11.51 months, P = 0.037), as well as TTR (median TTR: 8.81 vs 7.10 months, P = 0.046) representing an association with improved outcomes that favored the neoadjuvant approach among older patients alone. Conclusions: This comprehensive three-part study showed that administration of NAT, followed by surgical resection, seems to be safe and effective among patients ≥75 years of age. An aggressive approach should be offered to older adults undergoing multimodal treatment of PDAC. Competing Interests: The authors report no conflicts of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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