Neoadjuvant therapy offers longer survival than upfront surgery for poorly differentiated and higher stage pancreatic cancer

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Nurmi , A-M , Mustonen , H , Parviainen , H , Peltola , K , Haglund , C & Seppänen , H 2018 , ' Neoadjuvant therapy offers longer survival than upfront surgery for poorly differentiated and higher stage pancreatic cancer ' , Acta Oncologica , vol. 57 , no. 6 , pp. 799-806 . https://doi.org/10.1080/0284186X.2017.1415458

Title: Neoadjuvant therapy offers longer survival than upfront surgery for poorly differentiated and higher stage pancreatic cancer
Author: Nurmi, Anna-Maria; Mustonen, Harri; Parviainen, Helka; Peltola, Katriina; Haglund, Caj; Seppänen, Hanna
Contributor organization: Department of Surgery
HUS Abdominal Center
University of Helsinki
Clinicum
II kirurgian klinikka
Developmental and tumor biology research group
Department of Diagnostics and Therapeutics
HUS Medical Imaging Center
Department of Oncology
HUS Comprehensive Cancer Center
Translational Cancer Biology (TCB) Research Programme
Research Programs Unit
Date: 2018
Language: eng
Number of pages: 8
Belongs to series: Acta Oncologica
ISSN: 0284-186X
DOI: https://doi.org/10.1080/0284186X.2017.1415458
URI: http://hdl.handle.net/10138/311740
Abstract: Background: Neoadjuvant therapy for pancreatic cancer remains controversial. Our aim was to assess differences in survival, disease recurrence and histopathological tumor characteristics between patients treated with neoadjuvant therapy followed by subsequent surgery and patients undergoing upfront surgery.Material and methods: Out of 399 consecutive pancreatic ductal adenocarcinoma (PDAC) patients operated at Helsinki University Hospital in 2000-2015, 75 borderline resectable patients were treated with neoadjuvant therapy. Resectable propensity scored patients (n=150) underwent upfront surgery. Neoadjuvant therapy consisted of folfirinox, single gemcitabine or combined with cisplatin, nab-paclitaxel or capecitabine with or without radiation. Survival was calculated with Kaplan-Meier and compared with the Breslow test. Survival was determined from the start of treatment, being the first day of treatment for patients treated with neoadjuvant therapy and the date of surgery for others.Results: Between 2000 and 2015 median disease-specific survival (DSS) [34 vs. 26 months, p=.016] and disease-free survival (DFS) [22 vs. 13 months, p=.001] were longer in patients treated with neoadjuvant therapy than in those undergoing upfront surgery. Survival differences were not significant in the 2000s but were, in turn, among patients treated in the 2010s with better survival for patients treated with neoadjuvant therapy [DSS 35 vs. 26 months, p=.008 and DFS 25 vs. 13 months, p=.001]. Especially patients with poorly differentiated G3 tumors [DSS 30 vs. 11 months, p=.004 and DFS 21 vs. 7 months, p=.001] and higher stage IIB-III [DSS 34 vs. 20 months, p=.006 and DFS 21 vs. 10 months, p=.001] had longer survival when treated with neoadjuvant therapy.Conclusions: PDAC patients treated with neoadjuvant therapy had longer DSS and DFS than those undergoing upfront surgery. Neoadjuvant therapy benefits especially borderline resectable patients with higher stage and poorly differentiated tumors.
Subject: 3122 Cancers
SINGLE-INSTITUTION EXPERIENCE
DUCTAL ADENOCARCINOMA
SURGICAL COMPLICATIONS
GEMCITABINE
COMPLETION
MANAGEMENT
DISEASE
IMPACT
Peer reviewed: Yes
Usage restriction: openAccess
Self-archived version: acceptedVersion


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