Abstract | BACKGROUND: METHODS: The National Cancer Data Base was reviewed from 2002-2011 for patients with clinical, stage III adenocarcinoma of the head or body of the pancreas. Patients were categorized as neoadjuvant or surgery-first. The intention-to-treat analysis included all neoadjuvant therapy patients in whom a potentially curative operation was planned and all surgery-first patients for whom adjuvant therapy was recommended. Intention-to-treat overall survival was compared by Kaplan-Meier and Cox proportional hazards multivariable regression. RESULTS: A total of 593 patients were identified: 377 (63.6%) in the neoadjuvant cohort, wherein 104 (27.6%) experienced preoperative attrition, and 216 (36.4%) in the surgery-first cohort, of whom 30 (13.9%) failed to receive intended adjuvant chemotherapy. Intention-to-treat Kaplan-Meier analysis demonstrated superior survival for neoadjuvant compared to surgery-first (median overall survival 20.7 months vs 13.7 months, log rank P < .001). Intention-to-treat multivariable regression analysis revealed a decreased mortality hazard (hazard ratio = 0.68, 95% confidence interval 0.53-0.86, P = .0012) for neoadjuvant compared to surgery-first. CONCLUSION: Despite preoperative attrition, neoadjuvant therapy in clinical, stage III pancreatic cancer patients is associated with improved overall survival when compared to patients receiving surgery-first.
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Authors | Christopher R Shubert, John R Bergquist, Ryan T Groeschl, Elizabeth B Habermann, Patrick M Wilson, Mark J Truty, Rory L Smoot, Michael L Kendrick, David M Nagorney, Michael B Farnell |
Journal | Surgery
(Surgery)
Vol. 160
Issue 4
Pg. 1080-1096
(10 2016)
ISSN: 1532-7361 [Electronic] United States |
PMID | 27522556
(Publication Type: Comparative Study, Journal Article)
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Copyright | Copyright © 2016 Elsevier Inc. All rights reserved. |
Topics |
- Adenocarcinoma
(mortality, pathology, therapy)
- Adult
- Aged
- Chemotherapy, Adjuvant
- Cohort Studies
- Databases, Factual
- Disease-Free Survival
- Female
- Humans
- Intention to Treat Analysis
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Neoadjuvant Therapy
(methods)
- Neoplasm Invasiveness
(pathology)
- Neoplasm Recurrence, Local
(mortality, pathology, therapy)
- Neoplasm Staging
- Pancreatectomy
(methods, mortality)
- Pancreatic Neoplasms
(mortality, pathology, therapy)
- Prognosis
- Retrospective Studies
- Risk Assessment
- Survival Analysis
- Treatment Outcome
- United States
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