Neoadjuvant Therapy and Pancreatic Cancer Resection Outcomes: A Retrospective Analysis at a Quaternary Care Center

Pancreatic adenocarcinoma (PA) has a rising incidence and high mortality, with current overall 5-y survival being less than 15%. Whether outcomes may be improved by the use of neoadjuvant therapy prior to resection is not fully established.

Data from patients who underwent resection of PA between 2015 and 2024 at a single United States center were retrospectively reviewed. Patient records were stratified by receipt of neoadjuvant therapy (NAT). Outcomes were postresection overall survival, recurrence-free survival, and pathological features at resection.

Between 2015 and 2024, 313 patients underwent resection for PA, of whom 62 (19.8%) received NAT and 229 (73.2%) underwent upfront resection (UFR); 22 (7.0%) patients were excluded due to missing data. Of the 62 NAT patients, three (4.9%) demonstrated complete response on pathological examination, 44 (72%) demonstrated incomplete response, 12 (20%) demonstrated no response, and two had no report (3.1%). The NAT cohort exhibited significantly lower preoperative CA19-9 levels (P < 0.001) and lower T and N stages (P = 0.006 and P < 0.001, respectively), along with reduced rates of perineural and lymphovascular invasion (both P < 0.001). Complete tumor removal with negative margins (R0) was similar between both groups, 49 (79%) in the NAT group versus 169 (74%) in the UFR group (P = 0.4). Neither overall survival nor recurrence-free survival significantly differed between the NAT and UFR groups (hazard ratio= 1.17, 95% confidence interval: 0.76-1.78; hazard ratio= 0.93, 95% confidence intervals: 0.60-1.42, respectively).

In patients undergoing resection for pancreatic cancer, NAT was associated with less advanced pathologic features at resection, but these did not translate into improved postresection outcomes.