Trends in utilization of neoadjuvant therapy and short-term outcomes in resected pancreatic cancer

Am J Surg. 2017 Jul;214(1):80-88. doi: 10.1016/j.amjsurg.2016.08.015. Epub 2016 Sep 6.

Abstract

Background: Surgical resection and chemotherapy offer the only chance of long-term survival for pancreatic cancer. Neoadjuvant therapy (NAT) is increasingly used to optimize outcomes. Trends in NAT utilization and short-term outcomes in resected pancreatic cancer were evaluated.

Methods: The National Cancer Database (2003 to 2011) was analyzed for pancreatic cancer patients who underwent surgery ± NAT, evaluating utilization, 30- and 90-day mortality, hospital readmissions, and length of stay (LOS).

Results: About 16,007 underwent initial surgery and 1,736 received NAT. Over the past decade, initial surgery and multimodality NAT have steadily decreased, whereas the use of neoadjuvant radiation has remained low and the use of neoadjuvant chemotherapy (neoCT) has steadily increased. Thirty- and 90-day mortality rates and hospital readmissions were significantly higher for NAT vs initial surgery on univariate analysis. There was no significant difference in LOS or readmission rate. On multivariate analysis, neoCT had no significant impact on odds of mortality at 30 and 90 days (hazard ratio = .68, P = .285, hazard ratio = 1.32, P = .161, respectively). Advanced age, greater comorbidities, greater clinical stage disease, and resection with pancreaticoduodenectomy or total pancreatectomy negatively impacted 30- and 90-day mortality.

Conclusion: The use of neoCT has increased over the past decade and does not appear to adversely affect short-term outcomes, including 30- and 90-day mortality, LOS, and readmission rates.

Keywords: Neoadjuvant therapy; Pancreatic cancer; Perioperative outcome.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Carcinoma / mortality
  • Carcinoma / pathology
  • Carcinoma / therapy
  • Chemotherapy, Adjuvant / statistics & numerical data
  • Cohort Studies
  • Comorbidity
  • Databases, Factual
  • Female
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoadjuvant Therapy / statistics & numerical data*
  • Pancreatectomy / mortality
  • Pancreatic Neoplasms / mortality*
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / therapy*
  • Pancreaticoduodenectomy / mortality
  • Patient Readmission / statistics & numerical data
  • Radiotherapy, Adjuvant / statistics & numerical data
  • Retrospective Studies
  • United States / epidemiology
  • Young Adult