AI Article Synopsis
- The study explored the effectiveness of neoadjuvant therapy (NAT) for patients with resectable and borderline resectable pancreatic cancer, suggesting it may improve overall survival (OS) rates.
- Among patients with resectable disease, those receiving NAT had better OS compared to those who underwent surgery first, especially if tumor size was ≤25 mm and CA19-9 levels were <100 U/mL.
- For borderline resectable cases, delaying surgery until tumor markers are controlled showed significant OS benefits for patients receiving NAT.
Article Abstract
Purpose: We investigated true indication of neoadjuvant therapy (NAT) in resectable pancreatic cancer and the optimal surgical timing in borderline resectable pancreatic cancer.
Methods: A total of 687 patients with resectable or borderline resectable pancreatic cancer were enrolled. Survival analysis was performed by intention-to-treat analysis and propensity score matching (PSM) was conducted.
Results: In resectable disease, the NAT group showed better overall survival (OS) compared with the upfront group. Multivariate analysis identified CA19-9 level (≥100 U/mL) and lymph node metastasis to be prognostic factors, and a tumor size of 25 mm was the optimal cut-off value to predict lymph node metastasis. There was no significant survival difference between patients with a tumor size ≤25 mm and CA19-9 < 100 U/mL and those in the NAT group. In borderline resectable disease, OS in the NAT group was significantly better than that in the upfront group. CEA (≥5 ng/mL) and CA19-9 (≥100 U/mL) were identified as prognostic factors; however, the OS of patients fulfilling these factors was worse than that of the NAT group.
Conclusions: NAT could be unnecessary in patients with tumor size ≤25 mm and CA19-9 < 100 U/mL in resectable disease. In borderline resectable disease, surgery should be delayed until tumor marker levels are well controlled.
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| http://dx.doi.org/10.1016/j.pan.2024.03.012 | DOI Listing |
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