Early PDAC: neoadjuvant therapy reduces unexpected upstaging

  • HPB (Oxford)

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Neoadjuvant therapy (NAT) is associated with less unexpected restaging, reduction in nodal positivity, and improved survival in patients with early-stage pancreatic ductal adenocarcinoma (PDAC).

Why this matters

  • NAT has been shown to be effective in patients with early, potentially resectable disease, but uptake remains slow.

Study design

  • Retrospective analysis of 13,871 patients with clinical stage I-II PDAC from the National Cancer Database.
  • Funding: None.

Key results

  • 15.3% of patients underwent NAT; 84.7% had no NAT.
  • Frequency of NAT in this population increased from 11% in 2006 to 21% in 2013.
  • Patients who received NAT were younger (mean, 64 vs 67 years; P<.001 more likely to be treated at higher-volume facilities and have clinical stage ii disease>
  • NAT vs surgery first:
    • R0 resection: 88.7% vs 83.2% (P<.001>
    • N0: 53.8% vs 30.9% (P<.001>
    • Pathologic downstaging: 40.1% vs 18.3% (P<.001>
    • Upstaging from I to IIa+: 46.7% vs 65.5%.
    • Upstaging from II to III+: 14.0% vs 33.0%.
  • NAT was associated with better OS (HR, 0.77; 95% CI, 0.73-0.82), with a significant effect size (HR, 1.13; 95% CI, 1.07-1.20; reference group = NAT).

Limitations

  • Retrospective analysis.

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