Sistema de Salut de Catalunya
Institut Català de la Salut
[Rangelova E] Department of Upper Abdominal Surgery at Sahlgrenska University Hospital, Gothenburg, Sweden. Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. [Stoop TF] Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands. Cancer Center Amsterdam, Amsterdam, The Netherlands. Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, USA. [van Ramshorst TME] Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands. Cancer Center Amsterdam, Amsterdam, The Netherlands. Department of Surgery, Fondazione Poliambulanza, Instituto Ospedaliero, Brescia, Italy. [Ali M] Cancer Center Amsterdam, Amsterdam, The Netherlands. Amsterdam UMC, Location Vrije Universiteit, Department of Surgery, Amsterdam, The Netherlands. [van Bodegraven EA] Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands. Cancer Center Amsterdam, Amsterdam, The Netherlands. [Javed AA] Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands. Cancer Center Amsterdam, Amsterdam, The Netherlands. Department of Surgical Oncology, Department of Surgery, New York University Medical Center, New York, USA. [Pando E, Mata R] Universitat Autònoma de Barcelona, Barcelona, Spain. Servei de Cirurgia Hepatobiliopancreàtica i Trasplantaments, Vall d’Hebron Hospital Universitari, Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
2025-06-13T10:28:58Z
2025-06-13T10:28:58Z
2025-05
Neoadjuvant therapy; Pancreatic adenocarcinoma; Resectable
Terapia neoadyuvante; Adenocarcinoma pancreático; Resecable
Teràpia neoadjuvant; Adenocarcinoma pancreàtic; Resecable
Background: Left-sided pancreatic cancer is associated with worse overall survival (OS) compared with right-sided pancreatic cancer. Although neoadjuvant therapy is currently seen as not effective in patients with resectable pancreatic cancer (RPC), current randomized trials included mostly patients with right-sided RPC. The purpose of this study was to assess the association between neoadjuvant therapy and OS in patients with left-sided RPC compared with upfront surgery. Patients and methods: This was an international multicenter retrospective study including consecutive patients after left-sided pancreatic resection for pathology-proven RPC, either after neoadjuvant therapy or upfront surgery in 76 centers from 18 countries on 4 continents (2013-2019). The primary endpoint was OS from diagnosis. Time-dependent Cox regression analysis was carried out to investigate the association of neoadjuvant therapy with OS, adjusting for confounders at the time of diagnosis. Adjusted OS probabilities were calculated. Results: Overall, 2282 patients after left-sided pancreatic resection for RPC were included of whom 290 patients (13%) received neoadjuvant therapy. The most common neoadjuvant regimens were (m)FOLFIRINOX (38%) and gemcitabine-nab-paclitaxel (22%). After upfront surgery, 72% of patients received adjuvant chemotherapy, mostly a single-agent regimen (74%). Neoadjuvant therapy was associated with prolonged OS compared with upfront surgery (adjusted hazard ratio 0.69, 95% confidence interval 0.58-0.83) with an adjusted median OS of 53 versus 37 months (P = 0.0003) and adjusted 5-year OS rates of 47% versus 35% (P = 0.0001) compared with upfront surgery. Interaction analysis demonstrated a stronger effect of neoadjuvant therapy in patients with a larger tumor (Pinteraction = 0.003) and higher serum carbohydrate antigen 19-9 (CA19-9; Pinteraction = 0.005). In contrast, the effect of neoadjuvant therapy was not enhanced for splenic artery (Pinteraction = 0.43), splenic vein (Pinteraction = 0.30), retroperitoneal (Pinteraction = 0.84), and multivisceral (Pinteraction = 0.96) involvement. Conclusions: Neoadjuvant therapy in patients with left-sided RPC was associated with improved OS compared with upfront surgery. The impact of neoadjuvant therapy increased with larger tumor size and higher serum CA19-9 at diagnosis. Randomized controlled trials on neoadjuvant therapy specifically in patients with left-sided RPC are needed.
Article
Published version
English
Pàncrees - Càncer - Tractament; Pàncrees - Càncer - Cirurgia; DISEASES::Neoplasms::Neoplasms by Site::Digestive System Neoplasms::Pancreatic Neoplasms; Other subheadings::Other subheadings::/therapy; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Combined Modality Therapy::Neoadjuvant Therapy; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Digestive System Surgical Procedures::Pancreatectomy; ENFERMEDADES::neoplasias::neoplasias por localización::neoplasias del sistema digestivo::neoplasias pancreáticas; Otros calificadores::Otros calificadores::/terapia; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::tratamiento combinado::tratamiento neoadyuvante; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos del sistema digestivo::pancreatectomía
Elsevier
Annals of Oncology;36(5)
https://doi.org/10.1016/j.annonc.2024.12.015
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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