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

INTRODUCTION: 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.

MATERIALS AND METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.