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