Impact of Neoadjuvant Therapy on Oncological Outcomes of Patients With Distal Pancreatic Adenocarcinoma.

Autor: Chopra A; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Gebran A; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Khachfe H; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Asmar RE; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Nassour I; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Narayanan S; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., AlMasri S; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Singhi A; Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Lee K; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Zureikat A; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Paniccia A; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2024 Sep 30. Date of Electronic Publication: 2024 Sep 30.
DOI: 10.1002/jso.27856
Abstrakt: Background: Distal pancreatic ductal adenocarcinoma (D-PDAC) often presents at an advanced stage. The efficacy of neoadjuvant therapy (NAT) in improving outcomes for D-PDAC is not well-established. This study evaluates the impact of NAT on the oncological outcomes of patients with D-PDAC.
Methods: A retrospective cohort study of consecutive patients with resectable and borderline-resectable D-PDAC treated at a single center from 2012 to 2020 was performed. Stratification was based on initial treatment-NAT or surgery first (SF). Survival analysis, following intention-to-treat framework, used Kaplan-Meier and Cox regression to assess NAT's impact on progression-free survival (PFS) and overall survival (OS) of D-PDAC.
Results: Among 141 patients (median age 69.8 years, 51.8% females) included in the study, 71 (50.4%) received NAT and 70 (49.6%) were planned for SF. Patients receiving NAT were younger (65.9 vs. 72.6 years) and had higher incidence of borderline-resectable disease (31% vs. 4.3%) (both p < 0.05) than those undergoing SF. Thirteen patients (18.3%) undergoing NAT and five (7.1%) in SF group, failed to undergo resection. Univariate comparison showed no difference in the PFS (SF:13.97 vs. NAT:17.00 months, p = 0.6), and OS (SF:23.73 vs. NAT:32.53 months, p = 0.35). Multivariate Cox regression analysis noted significantly improved PFS (HR = 0.64, 95%CI = 0.42-0.96, p = 0.031) and OS (HR = 0.60, 95%CI = 0.39-0.93, p = 0.021) with NAT.
Conclusion: NAT is associated with improved PFS and OS in patients with -D-PDAC. Further randomized controlled trials are warranted to confirm these findings.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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