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Is Adjuvant Therapy Necessary for All Patients with Localized Pancreatic Cancer Who Have Received Neoadjuvant Therapy? J Gastrointest Surg 2017 Nov;21(11):1793-1803

Date

08/30/2017

Pubmed ID

28849366

DOI

10.1007/s11605-017-3544-5

Scopus ID

2-s2.0-85028529403   15 Citations

Abstract

BACKGROUND: Among patients with localized pancreatic cancer (PC), the benefit of adjuvant therapy after neoadjuvant therapy and surgery is unknown.

METHODS: Patients with localized PC who completed all intended neoadjuvant therapy and surgery were categorized based on the receipt of adjuvant therapy and by pathologic lymph node status (LN-/LN+).

RESULTS: Data was available from 234 consecutive patients, 121 (52%) with resectable and 113 (48%) with borderline resectable PC. Of the 234 patients, 92 (39%) were LN+ and 142 (61%) were LN-. The median overall survival (OS) for the 234 patients was 39 months, 42.3 months for patients who received any adjuvant therapy and 34.1 months for those who did not (p = 0.29). Of the 92 LN+ patients, the median OS with and without adjuvant therapy was 29.5 and 23.2 months, respectively (p = 0.02). Of the142 LN- patients, the median OS was 45 months with or without adjuvant therapy (p = 0.86). In an adjusted hazard model, additional adjuvant therapy had a significant protective effect among LN+ patients (HR 0.39; 95% CI 0.21-0.70; p = 0.002) but not in LN- patients (HR 0.89; 95% CI 0.53-1.52; p = 0.68).

CONCLUSION: Among patients with localized PC who received neoadjuvant therapy and surgery, the benefit of adjuvant therapy was limited to those with node-positive disease.

Author List

Barnes CA, Krepline AN, Aldakkak M, Clarke CN, Christians KK, Khan AH, Hunt BC, Ritch PS, George B, Hall WA, Erickson BA, Evans DB, Tsai S

Authors

Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Callisia N. Clarke MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Beth A. Erickson MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Ben George MD Associate Professor in the Medicine department at Medical College of Wisconsin
William Adrian Hall MD Associate Professor in the Radiation Oncology department at Medical College of Wisconsin
Bryan C. Hunt MD Assistant Professor in the Pathology department at Medical College of Wisconsin
Abdul Haq Khan MD Associate Professor in the Medicine department at Medical College of Wisconsin
Susan Tsai MD Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Antineoplastic Agents
Combined Modality Therapy
Female
Humans
Male
Middle Aged
Pancreatectomy
Pancreatic Neoplasms
Patient Selection
Proportional Hazards Models
Retrospective Studies
Treatment Outcome