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The survival effect of neoadjuvant therapy and neoadjuvant plus adjuvant therapy on pancreatic ductal adenocarcinoma

Hao Hu1, Yang Xu1, Qiang Zhang1

  • 1Department of Hepatobiliary Surgery, Aerospace Center Hospital, Beijing, China.

Expert Review of Anticancer Therapy
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Summary

Neoadjuvant therapy plus adjuvant therapy (NATAT) improves survival in advanced pancreatic ductal adenocarcinoma (PDAC) stages III and IV. This approach may benefit select patients with metastatic disease undergoing radical resection.

Keywords:
Adjuvant therapyneoadjuvant therapyoverall survivalpancreatic ductal adenocarcinomapropensity score matchingsurveillance epidemiology and end results

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastroenterology

Background:

  • Pancreatic ductal adenocarcinoma (PDAC) treatment involves adjuvant therapy (AT) and neoadjuvant therapy (NAT).
  • The survival benefit of AT after NAT and radical resection across all TNM stages is not fully established.
  • Determining optimal treatment sequencing is critical for improving PDAC patient outcomes.

Purpose of the Study:

  • To evaluate the survival impact of different treatment strategies in pancreatic ductal adenocarcinoma (PDAC) patients.
  • To compare adjuvant therapy (AT) versus neoadjuvant therapy plus adjuvant therapy (NATAT) in PDAC.
  • To identify specific TNM stages where NATAT offers a survival advantage.

Main Methods:

  • Retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database (2010-2019).
  • Analysis included 13,868 PDAC patients who underwent radical surgery.
  • Statistical methods comprised Pearson's chi-square test, Cox regression, Kaplan-Meier plots, Log-rank tests, and propensity score matching (PSM).

Main Results:

  • Propensity score matching identified significant survival differences between AT and NATAT (p=0.023) and between NAT and NATAT (p<0.001).
  • A survival advantage for NATAT was observed in AJCC 8th TNM stage III and IV disease, excluding T4N0M0.
  • Some stage IV PDAC patients receiving NATAT showed survival comparable to those without metastasis.

Conclusions:

  • Neoadjuvant therapy plus adjuvant therapy (NATAT) may improve survival for PDAC patients in advanced TNM stages (III and IV), including N2 resectable disease.
  • Certain patients with M1 (metastatic) PDAC may benefit from combined systemic therapy and radical resection.
  • This study highlights the potential of NATAT in improving outcomes for specific PDAC patient subgroups.