Survival in Locally Advanced Pancreatic Cancer After Neoadjuvant Therapy and Surgical Resection

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Locally advanced pancreatic cancer (LAPC) poses treatment challenges.
• Neoadjuvant therapy is increasingly used for LAPC, with some patients showing favorable responses.
• The survival benefit of surgical resection following neoadjuvant therapy in LAPC remains unclear.

Purpose of the Study:

• To determine the survival rates of patients with LAPC.
• To evaluate the impact of surgical resection after neoadjuvant therapy on patient outcomes.
• To identify factors influencing resectability and survival in LAPC.

Main Methods:

• Retrospective analysis of 415 LAPC patients treated between January 2013 and September 2017.
• Documentation of neoadjuvant treatment regimens (FOLFIRINOX, gemcitabine-based) and surgical resection data.
• Comparison of overall survival (OS) between resected and non-resected patient groups.

Main Results:

• Only 20% (84/415) of LAPC patients underwent primary tumor resection after neoadjuvant therapy.
• FOLFIRINOX and stereotactic body radiation therapy were associated with higher resection rates.
• Resected patients demonstrated significantly longer median OS (35.3 months) compared to non-resected patients (16.3 months), P < 0.001.

Conclusions:

• Surgical resection is feasible in a carefully selected group of LAPC patients post-neoadjuvant therapy.
• Resection is associated with a significant improvement in median overall survival.
• Patient selection criteria, including performance status and tumor markers, are crucial for successful surgical outcomes.