Preoperative downstaging of pancreatic cancer is associated with improved survival after multi-agent chemotherapy, but not after radiation

Authors

Laura Nicolais, Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland, ME, USA; Tufts University Clinical and Translational Science Graduate Program, Graduate School of Biomedical Sciences, Boston, MA, USA.
Austin W. Brown, Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland, ME, USA.
Abdimajid Mohamed, Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland, ME, USA.
David E. Clark, Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland, ME, USA.
Timothy L. Fitzgerald, Division of Surgical Oncology, Tufts University School of Medicine-Maine Medical Center, Portland, ME, USA

Document Type

Article

Publication Date

3-31-2023

Institution/Department

Oncology; Surgery

Journal Title

Surgical oncology

Abstract

BACKGROUND: Downstaging has been associated with improved survival for many cancers. However, the implications of downstaging are unclear for pancreatic cancer in an era of effective neoadjuvant systemic chemotherapy. METHODS: NCDB retrospective cohort study of resected pancreatic carcinoma treated with neoadjuvant therapy. RESULTS: The study included 73,985 patients: 66,589 with no neoadjuvant therapy, 2,102 neoadjuvant radiation therapy (N-RT), 3,195 neoadjuvant multiagent chemotherapy (N-MAC) and 2.099 with both neoadjuvant radiation and multiagent chemotherapy. There was increased use of N-MAC over the period of this study. Patients selected for treatment with N-MAC had longer survival from surgery on univariate (23.1 vs. 18.7 months, p = < 0.01) and multivariate analyses HR 0.81 (0.76-0.87, p < 0.001) compared to those selected with N-RT. Downstaging was similar in N-RT and N-MAC groups (25.1 vs. 24.1%, p = 0.43). Downstaging following N-MAC was associated with a survival benefit, HR 0.85 (0.74-0.98). However, downstaging following N-RT was not associated with a survival advantage, HR 1.12 (0.99-0.99). CONCLUSION: Clinicians have rapidly adopted N-MAC for treatment of pancreatic cancer. Although the rates of downstaging are similar between treatment groups, response translates into increased survival only with N-MAC and not with N-RT.

Comments

Laura Nicolais- Resident

First Page

101939

Recommended Citation

Nicolais L, Brown AW, Mohamed A, Clark DE, Fitzgerald TL. Preoperative downstaging of pancreatic cancer is associated with improved survival after multi-agent chemotherapy, but not after radiation [published online ahead of print, 2023 Mar 31]. Surg Oncol. 2023;48:101939. doi:10.1016/j.suronc.2023.101939