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Is There a Benefit to Adjuvant Chemotherapy in Resected, Early Stage Pancreatic Ductal Adenocarcinoma?

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The role of systemic therapy for Stage IA pancreatic ductal adenocarcinoma (PDAC) is unclear. The aim of our study was to evaluate the impact of adjuvant chemotherapy (AC) on survival in patients with early stage disease.

Methods

The National Cancer Database was queried from 2006 to 2017 for resected pT1N0M0 (Stage 1A) PDAC. Exclusion criteria included neoadjuvant therapy, radiation, or those who suffered a 90-day mortality.

Results

Of the 1526 patients included in the study, 42.2% received AC and 57.8% underwent surgery alone. Patients who received AC were younger, had fewer comorbidities, and were more likely to have private insurance, compared with those treated with surgery alone. Patients who received AC had longer median overall survival (OS) compared with those who underwent surgery alone (105.7 months vs 72.0 months, p < 0.01). Subset analyses based on individual “good” prognostic features (size ≤ 1.0 cm, lymphovascular invasion negative, well/moderately differentiated, margin negative resection) demonstrated improved OS with AC. Following propensity score matching based on key clinicopathologic features, AC remained associated with improved median OS (83.7 months vs 59.8 months, p < 0.01). However, in the cohort with body/tail tumors (101.2 months vs 95.0 months, p = 0.19) and those with all “good” prognostic features (95.9 months vs 90.6 months, p = 0.15), AC was not associated with improved survival.

Conclusions

In resected, Stage IA PDAC, AC is associated with improved overall survival in the vast majority of patients; however, in select cohorts the role of AC is unclear. Further study is needed to tailor treatment to individual patients with PDAC.

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Acknowledgment

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The authors have no grants or financial support to report.

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Authors and Affiliations

  1. Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Kevin M. Turner MD, Aaron M. Delman MD & Allison M. Ammann MD

  2. Department of Internal Medicine, Division of Hematology & Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Davendra Sohal MD & Olugbenga Olowokure MD

  3. Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Kyuran A. Choe MD

  4. Department of Internal Medicine, Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Milton T. Smith MD

  5. Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Jordan R. Kharofa MD

  6. Department of Surgery, Division of Surgical Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Syed A. Ahmad MD, Gregory C. Wilson MD & Sameer H. Patel MD

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  1. Kevin M. Turner MD
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  2. Aaron M. Delman MD
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Correspondence to Sameer H. Patel MD.

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10434_2022_11580_MOESM1_ESM.eps

Supplementary Figure 1 Utilization of Chemotherapy in Stage IA Pancreatic Cancer. Use of adjuvantchemotherapy among all patients undergoing surgical resection and classification of type of chemotherapeutic regimen (single vs. multi-agent) among patients who received adjuvant chemotherapy. Adjuvant Chemotherapy (AC)

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Turner, K.M., Delman, A.M., Ammann, A.M. et al. Is There a Benefit to Adjuvant Chemotherapy in Resected, Early Stage Pancreatic Ductal Adenocarcinoma?. Ann Surg Oncol 29, 4610–4619 (2022). https://doi.org/10.1245/s10434-022-11580-7

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  • DOI: https://doi.org/10.1245/s10434-022-11580-7

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