Smoking history is associated with reduced efficacy of neoadjuvant therapy in pancreatic adenocarcinoma.

Autor:	Akumuo RC; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States; Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States. Electronic address: rita.akumuo@tuhs.temple.edu., Reddy SP; Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States., Westwood C; Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States., Devarajan K; Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States., Barrak D; Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States., Reddy SS; Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States., Villano AM; Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States.
Jazyk:	angličtina
Zdroj:	Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2024 May; Vol. 28 (5), pp. 605-610. Date of Electronic Publication: 2024 Jan 23.
DOI:	10.1016/j.gassur.2024.01.007
Abstrakt:	Background: Differential responses to neoadjuvant therapy (NAT) exist in pancreatic ductal adenocarcinoma (PDAC); however, contributing factors are poorly understood. Tobacco smoke is a common risk factor for PDAC, with nicotine-induced chemoresistance observed in other cancers. This study aimed to explore the potential association between tobacco use and NAT efficacy in PDAC. Methods: A single-center, retrospective analysis was conducted that included all consecutive patients with PDAC who underwent surgical resection after NAT with a documented smoking history (N = 208). NAT response was measured as percentage fibrosis in the surgical specimen. Multivariable models controlled for covariates and survival were modeled using the Kaplan-Meier method. Results: Postoperatively, major responses to NAT (>95% fibrosis) were less frequently observed in smokers than in nonsmokers (13.7% vs 30.4%, respectively; P = .021). Pathologic complete responses were similarly less frequent in smokers than in nonsmokers (2.1% vs 9.9%, respectively; P = .023). On multivariate analysis controlling for covariates, smoking history remained independently associated with lower odds of major fibrosis (odds ratio [OR], 0.25; 95% CI, 0.10-0.59; P = .002) and pathologic complete response (OR, 0.21; 95% CI, 0.03-0.84; P = .05). The median overall survival was significantly longer in nonsmokers than in smokers (39.1 vs 26.6 months, respectively; P = .05). Conclusion: Tobacco use was associated with diminished pathologic responses to NAT. Future research to understand the biology underlying this observation is warranted and may inform differential NAT approaches or counseling among these populations. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
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