AI Article Synopsis
- R0 resection is the ideal surgical approach for pancreatic cancer, but when it's not possible (R1/R2 resections), this study investigates whether these patients have better outcomes compared to those who only receive chemotherapy.
- The research analyzed Stage II pancreatic cancer patients who went through either R1/R2 surgery with or without chemotherapy against those treated with chemotherapy alone, revealing that patients undergoing R1/R2 surgeries had better survival rates, particularly when they also received neoadjuvant chemotherapy.
- Results indicated that R1/R2 resections provide improved survival compared to chemotherapy alone, with survival times averaging around 19.75 months for neoadjuvant surgery patients versus 10.12 months for chemotherapy-only patients
Article Abstract
Background: R0 resection for pancreatic cancer is considered standard of care, but is not always achieved. This study looks at R1/R2 resection outcomes compared with chemotherapy alone. Our hypothesis is that patients with margin-positive disease have better outcomes than those receiving chemotherapy alone.
Study Design: Stage II pancreatic cancer patients who underwent R1/R2 surgery with/without neoadjuvant chemotherapy, from the National Cancer Database (NCDB) 2010 to 2017 were identified and compared with similar staged patients who received chemotherapy alone. The surgical group was then analyzed by subset based on receipt of chemotherapy: upfront surgery (+/- adjuvant therapy) and neoadjuvant therapy followed by surgery (+/- adjuvant therapy).
Results: There were 11,699 Stage II pancreatic cancer patients included, 9,521 (81.4%) of whom were treated with chemotherapy alone, 15.7% (n = 1,836) had upfront surgery, and 2.9% (n = 342) had neoadjuvant therapy with surgery. R1/R2 neoadjuvant patients had the best overall survival at a mean of 19.75 months (95% CI 17.91, 22.28) compared with the upfront surgery group (17.77 months, 95% CI 15.64, 19.55) and the chemotherapy alone group (10.12 months, 95% CI 8.97, 11.50) (hazard ratio [HR] 0.46 upfront surgery and 0.32 neoadjuvant group, respectively, p < 0.0001). Even with R2 resection, survival was better in surgical patients compared with patients who underwent chemotherapy only (15.76 mo vs 10.22 mo, p = 0.06). Patients with R1/R2 resections had improved survival if they received neoadjuvant/adjuvant chemotherapy, though the survival rates were significantly lower than those with standard R0 resections (n = 16,129).
Conclusions: R1 resection has benefit over chemotherapy alone in pancreatic cancer. Pancreatic cancer patients who are left with microscopic R1 disease have better survival than without surgery, particularly in the setting of neoadjuvant therapy.
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| http://dx.doi.org/10.1016/j.jamcollsurg.2021.02.020 | DOI Listing |
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