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Optimal Upfront Treatment in Surgically Resectable Pancreatic Cancer Candidates: A High-Volume Center Retrospective
Sarah Maloney1,2,3, Malinda Itchins1,2,3, Jennifer Arena1,3,4
1Faculty of Medicine and Health Sciences, Northern Clinical School, The University of Sydney, Sydney, NSW 2065, Australia.
Journal of Clinical Medicine
|July 2, 2021
Summary
Upfront surgery may benefit early-stage pancreatic cancer patients over neoadjuvant chemotherapy. Tumor viability and grade are key prognostic markers. Further trials are needed for optimal treatment pathways.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Pancreatic adenocarcinoma has poor prognosis, with limited resectable cases at diagnosis.
- Neoadjuvant chemotherapy is increasingly used for resectable pancreatic cancer, but lacks randomized trial support over upfront surgery.
- Treatment decisions for resectable pancreatic cancer require careful consideration of patient outcomes.
Purpose of the Study:
- To compare upfront surgery versus neoadjuvant chemotherapy in resectable pancreatic cancer.
- To identify prognostic markers for patients with resectable pancreatic cancer.
- To evaluate treatment pathways for optimizing patient survival.
Main Methods:
- Retrospective cohort analysis of 126 patients with resectable pancreatic cancer from 2013-2019.
- Comparison of patients receiving upfront surgery versus neoadjuvant chemotherapy based on a center's practice change.
- Analysis of overall survival (OS), R0 resection rates, tumor viability, and tumor grade.
Main Results:
- Patients with early-stage (1a) pancreatic cancer undergoing upfront surgery had longer median OS than those receiving neoadjuvant chemotherapy (24 vs. 21 months, p=0.028).
- No significant survival difference was observed for all patients regardless of stage.
- R0 resection rates were similar between upfront surgery and neoadjuvant chemotherapy groups (p=0.605).
- Tumor viability and tumor grade were identified as significant prognostic markers.
Conclusions:
- Upfront surgery may be a suitable option for select patients with low-volume resectable pancreatic cancer.
- The trend towards neoadjuvant chemotherapy for all resectable cases may not be universally optimal.
- Prospective clinical trials incorporating biomarkers are necessary to determine the optimal therapy pathway for resectable pancreatic cancer.
