Journal of gastroenterology · 2026
Neoadjuvant and adjuvant treatment for pancreatic ductal adenocarcinoma in patients over 80 years old based on a nationwide clinical database.
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Hashimoto Daisuke, Hirakawa Shinya, Mizuma Masamichi, Tachimori Hisateru, Yamaki So, Itoi Takao, Egawa Shinichi, Kodama Yuzo, Nakata Kohei, Hamada Shin, Yasuda Ichiro, Unno Michiaki, Kakeji Yoshihiro, Shirabe Ken, Satoi Sohei, Masamune Atsushi, Takeyama Yoshifumi
Аннотация
BACKGROUND: The proportion of elderly patients with pancreatic ductal adenocarcinoma (PDAC) is increasing. This study aimed to investigate whether neoadjuvant treatment (NAT) and adjuvant therapy (AT) are effective in PDAC patients over 80 years of age.
METHODS: Patients over 80 years of age who underwent pancreatectomy for PDAC in 2012-2020 and were recorded in the Japan Society for Gastroenterological Surgery and Japan Pancreas Society databases were included. Propensity score matching (PSM) analysis was performed to determine whether NAT and AT contribute to survival. In patients treated from 2017 onward, resectability status was incorporated into the PSM model.
RESULTS: Of the 3438 patients in the study population, the primary resectability-adjusted PSM analysis of NAT among patients treated from 2017 onward compared 274 matched pairs. The MST was 30.5 (95% CI, 26.2-NA) and 29.0 (95% CI, 22.3-38.0) months in the NAT and non-NAT groups, respectively, with no significant difference (p = 0.205 [stratified log-rank]). In a complementary full-cohort PSM analysis, 393 matched pairs were compared; the MST was 32.9 and 30.2 months, respectively, with no significant difference. In a PSM-matched comparison of 1213 patients who received AT versus 1213 patients who did not, MST was longer in the former (30.7 [95% CI, 27.3-33.2] versus 23.7 [95% CI, 21.8-26.1] months, p < 0.001 [stratified log-rank]).
CONCLUSION: NAT did not show a statistically significant survival benefit in PDAC patients aged 80 years or older, however, this finding should be interpreted with caution. In contrast, AT was associated with improved survival.
METHODS: Patients over 80 years of age who underwent pancreatectomy for PDAC in 2012-2020 and were recorded in the Japan Society for Gastroenterological Surgery and Japan Pancreas Society databases were included. Propensity score matching (PSM) analysis was performed to determine whether NAT and AT contribute to survival. In patients treated from 2017 onward, resectability status was incorporated into the PSM model.
RESULTS: Of the 3438 patients in the study population, the primary resectability-adjusted PSM analysis of NAT among patients treated from 2017 onward compared 274 matched pairs. The MST was 30.5 (95% CI, 26.2-NA) and 29.0 (95% CI, 22.3-38.0) months in the NAT and non-NAT groups, respectively, with no significant difference (p = 0.205 [stratified log-rank]). In a complementary full-cohort PSM analysis, 393 matched pairs were compared; the MST was 32.9 and 30.2 months, respectively, with no significant difference. In a PSM-matched comparison of 1213 patients who received AT versus 1213 patients who did not, MST was longer in the former (30.7 [95% CI, 27.3-33.2] versus 23.7 [95% CI, 21.8-26.1] months, p < 0.001 [stratified log-rank]).
CONCLUSION: NAT did not show a statistically significant survival benefit in PDAC patients aged 80 years or older, however, this finding should be interpreted with caution. In contrast, AT was associated with improved survival.