In a propensity score–matched analysis of National Cancer Database data reported in the Journal of Clinical Oncology, Mokdad et al found that neoadjuvant therapy followed by resection was associated with a survival benefit vs upfront resection. Patricio M. Polanco, MD, of the Division of Surgical Oncology, University of Texas Southwestern Medical Center, is the corresponding author of this article.
The analysis included adults with resected clinical stage I or II adenocarcinoma of the head of the pancreas from the National Cancer Database from 2006 to 2012. Patients who underwent neoadjuvant therapy followed by curative-intent resection were matched by propensity score with patients undergoing upfront resection. From among a total of 15,237 patients, 2,005 who received neoadjuvant therapy (95% of those receiving neoadjuvant therapy) were matched with 6,015 patients who underwent upfront resection.
Median overall survival was 26 months in the neoadjuvant therapy group vs 21 months in the upfront resection group (hazard ratio [HR] = 0.72, P < .01). Smaller proportions of patients in the neoadjuvant therapy group had pathologic T stage pT3 and T4 disease (73% vs 86%, P < .01), positive lymph nodes (48% vs 73%, P < .01), and a positive resection margin (17% vs 24%, P < .01). In the upfront resection group, 4,044 patients (67%) received adjuvant therapy. Median overall survival in those receiving adjuvant therapy was 23 months (HR = 0.83, P < .01, for neoadjuvant therapy vs adjuvant therapy).
The investigators concluded: “[Neoadjuvant therapy] followed by resection has a significant survival benefit compared with [upfront resection] in early-stage, resected pancreatic head adenocarcinoma. These findings support the use of [neoadjuvant therapy], particularly as a patient selection tool, in the management of resectable pancreatic adenocarcinoma.”