Hospital admission during neoadjuvant therapy for pancreatic ductal adenocarcinoma: prevalence, predictors, and prognosis.

BACKGROUND

Neoadjuvant therapy (NT) is increasingly utilized for localized pancreatic ductal adenocarcinoma (PDAC). The incidence of hospital admission during NT and its impact on clinical outcomes is poorly understood.

METHODS

Patients with localized PDAC who received intent-to-treat NT between 2018 and 2023 at a single institution were retrospectively reviewed. Hospital admission rates, reasons, and the impact on overall survival (OS) were assessed.

RESULTS

Among 305 patients, 58.4 % were male, 90.7 % were white, and median age was 66. Patients had potentially resectable (31.1 %), borderline resectable (36.7 %), and locally advanced disease (32.1 %). The median duration of NT was 119 days. Overall, 80 (26.2 %) patients required hospital admission during NT (range 1-5). The most common reasons for admission were fever/infection (33.8 %) and gastrointestinal symptoms (20.8 %). Factors associated with hospital admission included LA anatomic stage (OR 2.56; 95%CI: 1.22-5.39; p = 0.013) and BMI (OR 1.09; 95%CI: 1.04-1.15; p < 0.001). Hospital admission was associated with reduced odds of undergoing surgical resection (OR 0.27; 95%CI: 0.14-0.54; p < 0.001) and worse OS (median 14.6 months; 95%CI: 11.3-18.0 vs 22.6 months; 95%CI: 17.2-28.1; p < 0.001).

CONCLUSION

Hospital admission is common among patients with PDAC receiving NT and associated with worse outcomes. Further research on optimizing care delivery during NT is critical to improve outcomes.