Neoadjuvant chemotherapy improves outcomes in resectable pancreatic adenocarcinoma

Systemic chemotherapy is recommended for all stages of pancreatic ductal adenocarcinoma (PDAC), with a recent shift towards neoadjuvant chemotherapy (NAC) for resectable PDAC. The objective of this study was to compare outcomes of NAC versus AC for early stage resectable PDAC in the NCDB. Methods: Patients aged 18 or older with stage I or II PDAC in the National Cancer Database (NCDB) from 2010 to 2017 were identified. Logistic regression evaluated oncologic outcomes. Kaplan-Meier method followed by Cox proportional-hazards regression with inverse probability of treatment weighting (IPTW) using propensity score matching was used to compare overall survival (OS).

NAC led to a 13% risk reduction of a positive resection margin (OR:0.87; 95%CI 0.78-0.97), and a 59% decreased risk of positive lymph nodes (OR:0.41; 95%CI 0.38-0.45). The median OS for all patients treated with NAC was 2.56 years versus 1.95 years for surgery +/- AC (p< 0.001). NAC had an OS benefit for all patients (HR:0.80; 95%CI 0.78-0.83), as well as for Stage I (HR:0.89; 95%CI 0.84-0.94) and Stage II patients (HR:0.71; 95%CI 0.68-0.75).

NAC appears to be associated with a survival benefit for patients with resectable PDAC. NAC also decreased the risk of a positive resection margin and positive lymph nodes at the time of surgery.