AI Article Synopsis
- Downstaging, which is linked to better survival in various cancers, shows mixed results for patients with pancreatic cancer undergoing neoadjuvant therapies.
- A study analyzed nearly 74,000 pancreatic cancer patients and found that while neoadjuvant multiagent chemotherapy (N-MAC) improved post-surgery survival rates, neoadjuvant radiation therapy (N-RT) did not provide a similar survival advantage despite having similar downstaging rates.
- The research highlights that the growing use of N-MAC offers significant benefits for survival in pancreatic cancer patients, contrasting with N-RT, where downstaging does not correlate with improved outcomes.
Article Abstract
Background: Downstaging has been associated with improved survival for many cancers. However, the implications of downstaging are unclear for pancreatic cancer in an era of effective neoadjuvant systemic chemotherapy.
Methods: NCDB retrospective cohort study of resected pancreatic carcinoma treated with neoadjuvant therapy.
Results: The study included 73,985 patients: 66,589 with no neoadjuvant therapy, 2,102 neoadjuvant radiation therapy (N-RT), 3,195 neoadjuvant multiagent chemotherapy (N-MAC) and 2.099 with both neoadjuvant radiation and multiagent chemotherapy. There was increased use of N-MAC over the period of this study. Patients selected for treatment with N-MAC had longer survival from surgery on univariate (23.1 vs. 18.7 months, p = < 0.01) and multivariate analyses HR 0.81 (0.76-0.87, p < 0.001) compared to those selected with N-RT. Downstaging was similar in N-RT and N-MAC groups (25.1 vs. 24.1%, p = 0.43). Downstaging following N-MAC was associated with a survival benefit, HR 0.85 (0.74-0.98). However, downstaging following N-RT was not associated with a survival advantage, HR 1.12 (0.99-0.99).
Conclusion: Clinicians have rapidly adopted N-MAC for treatment of pancreatic cancer. Although the rates of downstaging are similar between treatment groups, response translates into increased survival only with N-MAC and not with N-RT.
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| http://dx.doi.org/10.1016/j.suronc.2023.101939 | DOI Listing |
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