Background: The International Study Group on Pancreatic Surgery recommends upfront surgery for resectable pancreatic cancer or borderline resectable-venous (BR-V) disease and neoadjuvant therapy (NAT) among those with arterial involvement (BR-A or locally advanced, LA). Though neoadjuvant therapy (NAT) is a promising strategy, outcomes are rarely reported on intention-to-treat (ITT) basis. This study presents ITT outcomes where pathways to surgery were in line with International Study Group on Pancreatic Surgery guidelines. Methods: Patients recommended for potentially curative treatment with PDAC between 2012 and 2017 (n = 345) were classified as resectable, BR-A/BR-V or LA, according to NCCN criteria. The primary outcome was overall survival. Secondary outcomes were resection rates, positive margins and toxicity among patients receiving NAT. Results: At surgery, the resection rates were 78% (172/221), 65% (35/54) and 54% (21/39) for those with resectable, BR-V and BR-A/LA disease, respectively (P < 0.0001). The median survival of those resected in the BR-A/LA cohort was 31 months. However, on an ITT basis, there was no significant difference in survival between resectable, BR-V and BR-A/LA disease (median: 19 versus 15 versus 19 months; P = 0.585). On review, some 31 (44%) patients of the BR-A/LA cohort either did not receive or did not complete NAT. Conclusion: To realize benefits of NAT, more patients need to complete NAT and to undergo resection. Upfront resection for BR-V disease is associated with equivalent outcomes to upfront surgery for resectable disease or NAT for BR-A/LA disease. Strategies to increase the proportion of patients who complete NAT and undergo resection are needed.
Intention to treat outcomes among patients with pancreatic cancer treated using International Study Group on Pancreatic Surgery recommended pathways for resectable and borderline resectable disease / S.K. Kamarajah, N. Chatzizacharias, J. Hodson, F. Marcon, M. Kalisvaart, P. Punia, Y. Ting Ma, B. Dasari, R. Marudanayagam, R.P. Sutcliffe, P. Muiesan, D.F. Mirza, J. Isaac, K.J. Roberts. - In: ANZ JOURNAL OF SURGERY. - ISSN 1445-1433. - 91:7-8(2021), pp. 1549-1557. [10.1111/ans.16643]
|Titolo:||Intention to treat outcomes among patients with pancreatic cancer treated using International Study Group on Pancreatic Surgery recommended pathways for resectable and borderline resectable disease|
|Parole Chiave:||Locally advanced; neoadjuvant; Pancreatic cancer; Survival; Antineoplastic Combined Chemotherapy Protocols; Humans; Intention to Treat Analysis; Neoadjuvant Therapy; Pancreatectomy; Pancreatic Neoplasms|
|Settore Scientifico Disciplinare:||Settore MED/18 - Chirurgia Generale|
|Data di pubblicazione:||2021|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1111/ans.16643|
|Appare nelle tipologie:||01 - Articolo su periodico|