Clinical benefits of neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreatic head: an observational study using inverse probability of treatment weighting.

Abstract

BACKGROUND:

The efficacy of neoadjuvant chemoradiotherapy (NACRT) and subset of pancreatic ductal adenocarcinoma (PDAC) patients who are most likely to benefit from this strategy remain elusive. The aim of this study was to investigate the effects of NACRT in patients with resectable (R) or borderline resectable (BR) adenocarcinoma of the pancreatic head. BR diseases were classified into two groups: lesions involving exclusively the portal vein system (BR-PV) and those abutting the major artery (BR-A).

METHODS:

A total of 504 patients treated with curative intent for PDAC were analyzed (R, n = 273; BR-PV, n = 129; BR-A, n = 102). Patients who underwent upfront surgery and those who underwent NACRT followed by surgery were compared using propensity score-matched and inverse probability of treatment-weighted analyses (UMIN000019719).

RESULTS:

No significant differences were noted in the incidences of curative resection among the three categories (R, BR-PV and BR-A). Propensity score-weighted logistic regression analysis revealed that the incidence of pathologically positive resection margins was reduced by NACRT only for BR patients. Among the propensity score-matched patients, NACRT rather than upfront surgery significantly prolonged the median survival time of BR-PV patients (28.4 vs. 20.1 months; P = 0.044) but not that of R-PDAC patients (28.6 vs. 33.7 months; P = 0.960). NACRT prolonged the median survival time of BR-A patients (18.1 vs. 10.0 months; P = 0.046), but the results remained unsatisfactory.

CONCLUSIONS:

These findings suggest that NACRT improves R0 rates and increases the survival of patients with BR-PV adenocarcinoma of the pancreatic head but not that of patients with R-PDAC.

• Authors: Tsutomu Fujii, Sohei Satoi, Suguru Yamada, Kenta Murotani, Hiroaki Yanagimoto, Hideki Takami, Tomohisa Yamamoto, Mitsuro Kanda, So Yamaki, Satoshi Hirooka, Masanori Kon, Yasuhiro Kodera
• Journal: Journal of gastroenterology (J Gastroenterol) Vol. 52 Issue 1 Pg. 81-93 (Jan 2017) ISSN: 1435-5922 [Electronic] Japan
• PMID: 27169844 (Publication Type: Comparative Study, Journal Article, Observational Study)

Topics

• Adenocarcinoma (pathology, therapy)
• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Pancreatic Ductal (pathology, therapy)
• Chemoradiotherapy (methods)
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Neoadjuvant Therapy (methods)
• Pancreatectomy (methods)
• Pancreatic Neoplasms (pathology, therapy)
• Probability
• Survival Rate
• Time Factors
• Treatment Outcome