TY - JOUR
T1 - Postoperative chemotherapy benefits patients who received preoperative therapy and pancreatectomy for pancreatic adenocarcinoma
AU - Perri, Giampaolo
AU - Prakash, Laura
AU - Qiao, Wei
AU - Varadhachary, Gauri R.
AU - Wolff, Robert
AU - Fogelman, David
AU - Overman, Michael
AU - Pant, Shubham
AU - Javle, Milind
AU - Koay, Eugene J.
AU - Herman, Joseph
AU - Kim, Michael
AU - Ikoma, Naruhiko
AU - Tzeng, Ching Wei
AU - Lee, Jeffrey E.
AU - Katz, Matthew H.G.
N1 - Funding Information:
From the *The Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; †The Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas; zThe Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; and §The Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. [email protected]. Supported by the NIH/NCI under award number P30CA016672. The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.annalsofsurgery.com). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0003-4932/20/27106-0996 DOI: 10.1097/SLA.0000000000003763
Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Objective:We sought to determine whether postoperative chemotherapy after preoperative therapy and pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) prolongs survival.Background:Data to support administering postoperative chemotherapy to patients who received preoperative therapy are lacking.Methods:All patients with PDAC who underwent pancreatectomy after preoperative therapy between 2010 and July 2017 at The University of Texas MD Anderson Cancer Center were identified. To control for selection bias, patients who received postoperative therapy and patients who did not were matched by propensity scores based on factors associated with the use of postoperative chemotherapy.Results:Among 245 patients treated with a median of 4 cycles of preoperative treatment and pancreatectomy, 155 (63%) initiated postoperative chemotherapy and 90 (37%) did not. Patients who received postoperative therapy had a higher median cancer antigen 19-9 level before surgery, larger median tumor diameter, higher rate of extrapancreatic invasion, and lower rate of pathologic major response. The propensity-matched cohort comprised 122 patients: 61 who received postoperative chemotherapy and 61 who did not. The median overall survival (OS) and recurrence free survival (RFS) for patients who received postoperative therapy were 42 and 17 months, respectively, versus 32 and 12 months for patients who did not (OS: P = 0.06; RFS: P = 0.04). Postoperative therapy was marginally associated with a longer OS (hazard ratio 0.55, 95% confidence interval 0.29-1.01; P = 0.05) and significantly associated with a longer RFS (hazard ratio 0.55, 95% confidence interval 0.29-0.96; P = 0.04).Conclusions:Despite being administered more frequently to patients with poor prognostic factors, postoperative chemotherapy after preoperative therapy and pancreatectomy for PDAC was of clinical benefit.
AB - Objective:We sought to determine whether postoperative chemotherapy after preoperative therapy and pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) prolongs survival.Background:Data to support administering postoperative chemotherapy to patients who received preoperative therapy are lacking.Methods:All patients with PDAC who underwent pancreatectomy after preoperative therapy between 2010 and July 2017 at The University of Texas MD Anderson Cancer Center were identified. To control for selection bias, patients who received postoperative therapy and patients who did not were matched by propensity scores based on factors associated with the use of postoperative chemotherapy.Results:Among 245 patients treated with a median of 4 cycles of preoperative treatment and pancreatectomy, 155 (63%) initiated postoperative chemotherapy and 90 (37%) did not. Patients who received postoperative therapy had a higher median cancer antigen 19-9 level before surgery, larger median tumor diameter, higher rate of extrapancreatic invasion, and lower rate of pathologic major response. The propensity-matched cohort comprised 122 patients: 61 who received postoperative chemotherapy and 61 who did not. The median overall survival (OS) and recurrence free survival (RFS) for patients who received postoperative therapy were 42 and 17 months, respectively, versus 32 and 12 months for patients who did not (OS: P = 0.06; RFS: P = 0.04). Postoperative therapy was marginally associated with a longer OS (hazard ratio 0.55, 95% confidence interval 0.29-1.01; P = 0.05) and significantly associated with a longer RFS (hazard ratio 0.55, 95% confidence interval 0.29-0.96; P = 0.04).Conclusions:Despite being administered more frequently to patients with poor prognostic factors, postoperative chemotherapy after preoperative therapy and pancreatectomy for PDAC was of clinical benefit.
KW - adjuvant therapy
KW - neoadjuvant therapy
KW - pancreatic adenocarcinoma
KW - pancreatic cancer
KW - pancreatic surgery
KW - postoperative therapy
KW - preoperative therapy
UR - http://www.scopus.com/inward/record.url?scp=85084696020&partnerID=8YFLogxK
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U2 - 10.1097/SLA.0000000000003763
DO - 10.1097/SLA.0000000000003763
M3 - Article
C2 - 31895709
AN - SCOPUS:85084696020
SN - 0003-4932
VL - 271
SP - 996
EP - 1002
JO - Annals of surgery
JF - Annals of surgery
IS - 6
ER -