Neoadjuvant multiagent chemotherapy or upfront surgery for primary resectable pancreatic cancer - A retrospective intention-to-treat analysis.

BACKGROUND

Randomized studies comparing neoadjuvant therapy and upfront surgery for primary resectable pancreatic cancer are conflicting. We aimed to determine whether multidisciplinary conference (MDC) recommendation of neoadjuvant multiagent chemotherapy is associated with survival benefits compared to upfront surgery.

METHODS

This retrospective study included patients with treatment-naive, biopsy-proven, primary resectable pancreatic adenocarcinoma discussed on MDCs at the University of Colorado Hospital in 2013-2021. Overall survival was compared by intention-to-treat, with Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models.

RESULTS

Among the 221 patients included, 116 were recommended neoadjuvant multiagent chemotherapy and 105 were recommended upfront surgery. In the neoadjuvant group, 106 patients (91.4%) completed at least two months of multiagent chemotherapy. The resection rates were 87/116 (75.0%) in the neoadjuvant group and 94/105 (89.5%) in the upfront surgery group (P= 0.005). The median overall survival was 41.9 months (95% CI 23.2-62.0) in the neoadjuvant group and 23.3 months (95% CI 19.0-31.6) in the upfront surgery group. Neoadjuvant therapy recommendation was associated with improved overall survival in the adjusted Cox model (HR: 0.65; 95% CI 0.44-0.95, P= 0.027).

CONCLUSION

Neoadjuvant therapy is associated with high multiagent chemotherapy completion rates and with improved overall survival compared to upfront surgery.