학술논문
Clinical and pathological factors associated with survival in patients with pancreatic cancer who receive adjuvant therapy after neoadjuvant therapy: A retrospective multi-institutional analysis.
Document Type
Academic Journal
Author
Shimizu T; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.; Maeda S; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.; Link J; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.; Deranteriassian A; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.; Premji A; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.; Verma A; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.; Chervu N; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.; Park J; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.; Girgis M; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.; Benharash P; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.; Hines J; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.; Wainberg Z; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.; Wolfgang C; Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.; Burns W; Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.; Yu J; Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.; Fernandez-Del Castillo C; Department of Surgery, Massachusetts General Hospital, Boston, MA.; Lillemoe K; Department of Surgery, Massachusetts General Hospital, Boston, MA.; Ferrone C; Department of Surgery, Massachusetts General Hospital, Boston, MA.; Donahue T; Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: tdonahue@mednet.ucla.edu.
Source
Publisher: Mosby Country of Publication: United States NLM ID: 0417347 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-7361 (Electronic) Linking ISSN: 00396060 NLM ISO Abbreviation: Surgery Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Neoadjuvant therapy is being increasingly used for patients with pancreatic cancer. The role of adjuvant therapy in these patients is unclear. The purpose of this study was to identify clinical and pathologic characteristics that are associated with longer overall survival in patients with pancreatic cancer who receive adjuvant therapy after neoadjuvant therapy.
Methods: This study was conducted using multi-institutional data. All patients underwent surgery after at least 1 cycle of neoadjuvant therapy for pancreatic cancer. Patients who died within 3 months after surgery and were known to have distant metastasis or macroscopic residual disease were excluded. Mann-Whitney U test, χ2 analysis, Kaplan-Meier plot, and univariate and multivariate Cox regression analysis were performed as statistical analyses.
Results: In the present study, 529 patients with resected pancreatic cancer after neoadjuvant therapy were reviewed. For neoadjuvant therapy, 177 (33.5%) patients received neoadjuvant chemotherapy, and 352 (66.5%) patients received neoadjuvant chemoradiotherapy. The median duration of neoadjuvant therapy was 7.0 months (interquartile range, 5.0-8.7). Patients were followed for a median of 23.0 months after surgery. Adjuvant therapy was administered to 297 (56.1%) patients and was not associated with longer overall survival for the entire cohort (24 vs 22 months, P = .31). Interaction analysis showed that adjuvant therapy was associated with longer overall survival in patients who received less than 4 months neoadjuvant therapy (hazard ratio 0.40; 95% confidence interval 0.17-0.95; P = .03) or who had microscopic margin positive surgical resections (hazard ratio 0.56; 95% confidence interval 0.33-0.93; P = .03).
Conclusion: In this retrospective study, there was a survival benefit associated with adjuvant therapy for patients who received less than 4 months of neoadjuvant therapy or had microscopic positive margins.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Methods: This study was conducted using multi-institutional data. All patients underwent surgery after at least 1 cycle of neoadjuvant therapy for pancreatic cancer. Patients who died within 3 months after surgery and were known to have distant metastasis or macroscopic residual disease were excluded. Mann-Whitney U test, χ
Results: In the present study, 529 patients with resected pancreatic cancer after neoadjuvant therapy were reviewed. For neoadjuvant therapy, 177 (33.5%) patients received neoadjuvant chemotherapy, and 352 (66.5%) patients received neoadjuvant chemoradiotherapy. The median duration of neoadjuvant therapy was 7.0 months (interquartile range, 5.0-8.7). Patients were followed for a median of 23.0 months after surgery. Adjuvant therapy was administered to 297 (56.1%) patients and was not associated with longer overall survival for the entire cohort (24 vs 22 months, P = .31). Interaction analysis showed that adjuvant therapy was associated with longer overall survival in patients who received less than 4 months neoadjuvant therapy (hazard ratio 0.40; 95% confidence interval 0.17-0.95; P = .03) or who had microscopic margin positive surgical resections (hazard ratio 0.56; 95% confidence interval 0.33-0.93; P = .03).
Conclusion: In this retrospective study, there was a survival benefit associated with adjuvant therapy for patients who received less than 4 months of neoadjuvant therapy or had microscopic positive margins.
(Copyright © 2024 Elsevier Inc. All rights reserved.)