Optimal Timing and Treatment Strategy for Pancreatic Cancer

Overview

Journal J Surg Oncol

Specialties General Surgery
Oncology

Date 2020 May 30

PMID 32470166

Citations 17

Authors

Adriana C Gamboa

Manali Rupji

Jeffrey M Switchenko

Rachel M Lee

Michael K Turgeon

Benjamin I Meyer

Maria C Russell

Kenneth Cardona

David A Kooby

Shishir K Maithel

Mihir M Shah

Affiliations

Soon will be listed here.

Abstract

Background: For pancreatic adenocarcinoma (PDAC), no studies have established any association between earlier treatment initiation and long-term outcomes. In addition, an optimal type of initial treatment for the localized disease remains ill-defined.

Methods: Patients in the National Cancer Database (2004-2015) with clinical stage I (CS-I) and II (CS-II) PDAC who underwent curative-intent resection were included. Optimal time from diagnosis-to-treatment including neoadjuvant chemotherapy, neoadjuvant chemoradiation, or upfront surgery was assessed. An optimal type of treatment was evaluated. The primary outcome was overall survival (OS).

Results: Among 29 167 patients, starting any treatment within 0 to 6 weeks was associated with improved median OS compared with 7 to 12 weeks (21.0 vs 20.1 months; P = .004). This persisted when accounting for sex, race, and Charlson-Deyo score (hazard ratio [HR], 0.94; P = 0.02) and on subset analysis for CS-I (23.5 vs 21.8 months; P = .04) and CS-II (19.4 vs 18.3 months; P = .03). Neoadjuvant chemotherapy was associated with improved OS compared with neoadjuvant chemoradiation (25.6 vs 22.7 months; P < .0001) or US (25.6 vs 20.1 months; P < .0001) even when accounting for sex, race, and Charlson-Deyo score (neoadjuvant chemoradiation: HR, 0.86; P < .001; US: HR, 0.79; P < .001). This improvement persisted in subset analysis with NC compared with neoadjuvant chemoradiation (CS-I: 28.6 vs 25.0 months; CS-II: 25.0 vs 22.9 months; both P < .0001) and to US (CS-I: 28.6 vs 22.9 months; CS-II: 24.7 vs 18.4 months; both P < .0001). On multivariable analysis for each CS-I/CS-II, NC remained associated with 20% improved survival compared with neoadjuvant chemoradiation or upfront surgery.

Conclusions: For PDAC, initiation of therapy within 6 weeks from diagnosis is associated with improved survival, with neoadjuvant chemotherapy associated with the best survival compared with neoadjuvant chemoradiation or upfront surgery.

Citing Articles

Minorities Face Delays to Pancreatic Cancer Treatment Regardless of Diagnosis Setting.

Fallon J, Standring O, Vithlani N, Demyan L, Shah M, Gazzara E Ann Surg Oncol. 2024; 31(8):4986-4996.

PMID: 38789617 PMC: 11236843. DOI: 10.1245/s10434-024-15352-3.

Impact of an Inter-Professional Clinic on Pancreatic Cancer Outcomes: A Retrospective Cohort Study.

Moffat G, Coyne Z, Albaba H, Aung K, Dodd A, Espin-Garcia O Curr Oncol. 2024; 31(5):2589-2597.

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Boggi U, Kauffmann E, Napoli N, Barreto S, Besselink M, Fusai G Updates Surg. 2024; 76(5):1573-1591.

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Time to surgery is not an oncological risk factor in patients with cholangiocarcinoma undergoing curative-intent liver surgery.

Mantas A, Liu D, Otto C, Heij L, Heise D, Bruners P Sci Rep. 2024; 14(1):1644.

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Time Kills: Impact of Socioeconomic Deprivation on Timely Access to Guideline-Concordant Treatment in Foregut Cancer.

Fonseca A, Ahmad R, Amin K, Tripathi M, Vobbilisetty V, Richman J J Am Coll Surg. 2024; 238(4):720-730.

PMID: 38205919 PMC: 11089897. DOI: 10.1097/XCS.0000000000000957.

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