Chemotherapy Versus Chemoradiation as Preoperative Therapy for Resectable Pancreatic Ductal Adenocarcinoma: A Propensity Score Adjusted Analysis

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Abstract

Objectives Although the use of neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma is increasing, the optimal preoperative treatment regimen remains poorly defined. Methods All patients with resectable pancreatic ductal adenocarcinoma who received preoperative chemotherapy alone (12%) or chemoradiation therapy (CRT) alone (88%) before pancreatectomy between 1999 and 2014 were included. Propensity score matching with inverse probability weighting was conducted based on age, baseline carbohydrate antigen 19-9, and procedure type. Results Patients who received preoperative CRT were more likely to undergo a margin negative (91% vs 79%, P < 0.01) and node negative (53% vs 23%, P < 0.01) resection and experience less locoregional recurrence (LR; 16% vs 33%, P < 0.01) but similar median overall survival (OS; 33.6 vs 26.4 months, P = 0.09). On multivariate analysis, carbohydrate antigen 19-9 (hazard ratio, 1.2; 95% confidence interval [CI], 1.1-1.3) and positive lymph nodes (hazard ratio, 1.5; 95% CI, 1.0-2.2) were associated with OS, whereas tumor size (odds ratio [OR], 1.5; 95% CI, 1.3-1.8), positive lymph nodes (OR, 3.1; 95% CI, 1.8-5.6), and preoperative chemotherapy (OR, 1.8; 95% CI, 1.1-2.9) were associated with LR. Conclusions Preoperative CRT is associated with less margin and lymph node positivity, reduced LR, and similar OS compared with preoperative chemotherapy.

Original languageEnglish (US)
Pages (from-to)216-222
Number of pages7
JournalPancreas
Volume48
Issue number2
DOIs
StatePublished - Feb 1 2019

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Propensity Score
Adenocarcinoma
Confidence Intervals
Drug Therapy
Lymph Nodes
Odds Ratio
Carbohydrates
Therapeutics
Antigens
Pancreatectomy
Neoadjuvant Therapy
Multivariate Analysis
Recurrence
Survival
Neoplasms

Keywords

  • FOLFIRINOX
  • neoadjuvant therapy
  • pancreas cancer
  • pancreatectomy
  • whipple

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology

Cite this

@article{759f6b853a954153a3b4df881f4d382a,
title = "Chemotherapy Versus Chemoradiation as Preoperative Therapy for Resectable Pancreatic Ductal Adenocarcinoma: A Propensity Score Adjusted Analysis",
abstract = "Objectives Although the use of neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma is increasing, the optimal preoperative treatment regimen remains poorly defined. Methods All patients with resectable pancreatic ductal adenocarcinoma who received preoperative chemotherapy alone (12{\%}) or chemoradiation therapy (CRT) alone (88{\%}) before pancreatectomy between 1999 and 2014 were included. Propensity score matching with inverse probability weighting was conducted based on age, baseline carbohydrate antigen 19-9, and procedure type. Results Patients who received preoperative CRT were more likely to undergo a margin negative (91{\%} vs 79{\%}, P < 0.01) and node negative (53{\%} vs 23{\%}, P < 0.01) resection and experience less locoregional recurrence (LR; 16{\%} vs 33{\%}, P < 0.01) but similar median overall survival (OS; 33.6 vs 26.4 months, P = 0.09). On multivariate analysis, carbohydrate antigen 19-9 (hazard ratio, 1.2; 95{\%} confidence interval [CI], 1.1-1.3) and positive lymph nodes (hazard ratio, 1.5; 95{\%} CI, 1.0-2.2) were associated with OS, whereas tumor size (odds ratio [OR], 1.5; 95{\%} CI, 1.3-1.8), positive lymph nodes (OR, 3.1; 95{\%} CI, 1.8-5.6), and preoperative chemotherapy (OR, 1.8; 95{\%} CI, 1.1-2.9) were associated with LR. Conclusions Preoperative CRT is associated with less margin and lymph node positivity, reduced LR, and similar OS compared with preoperative chemotherapy.",
keywords = "FOLFIRINOX, neoadjuvant therapy, pancreas cancer, pancreatectomy, whipple",
author = "Cloyd, {Jordan M.} and Chen, {Hsiang Chun} and Xuemei Wang and Tzeng, {Ching-Wei David} and Michael Kim and Aloia, {Thomas A} and Vauthey, {Jean Nicolas} and Lee, {Jeffrey E} and Katz, {Matthew Harold}",
year = "2019",
month = "2",
day = "1",
doi = "10.1097/MPA.0000000000001231",
language = "English (US)",
volume = "48",
pages = "216--222",
journal = "Pancreas",
issn = "0885-3177",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Chemotherapy Versus Chemoradiation as Preoperative Therapy for Resectable Pancreatic Ductal Adenocarcinoma

T2 - A Propensity Score Adjusted Analysis

AU - Cloyd, Jordan M.

AU - Chen, Hsiang Chun

AU - Wang, Xuemei

AU - Tzeng, Ching-Wei David

AU - Kim, Michael

AU - Aloia, Thomas A

AU - Vauthey, Jean Nicolas

AU - Lee, Jeffrey E

AU - Katz, Matthew Harold

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Objectives Although the use of neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma is increasing, the optimal preoperative treatment regimen remains poorly defined. Methods All patients with resectable pancreatic ductal adenocarcinoma who received preoperative chemotherapy alone (12%) or chemoradiation therapy (CRT) alone (88%) before pancreatectomy between 1999 and 2014 were included. Propensity score matching with inverse probability weighting was conducted based on age, baseline carbohydrate antigen 19-9, and procedure type. Results Patients who received preoperative CRT were more likely to undergo a margin negative (91% vs 79%, P < 0.01) and node negative (53% vs 23%, P < 0.01) resection and experience less locoregional recurrence (LR; 16% vs 33%, P < 0.01) but similar median overall survival (OS; 33.6 vs 26.4 months, P = 0.09). On multivariate analysis, carbohydrate antigen 19-9 (hazard ratio, 1.2; 95% confidence interval [CI], 1.1-1.3) and positive lymph nodes (hazard ratio, 1.5; 95% CI, 1.0-2.2) were associated with OS, whereas tumor size (odds ratio [OR], 1.5; 95% CI, 1.3-1.8), positive lymph nodes (OR, 3.1; 95% CI, 1.8-5.6), and preoperative chemotherapy (OR, 1.8; 95% CI, 1.1-2.9) were associated with LR. Conclusions Preoperative CRT is associated with less margin and lymph node positivity, reduced LR, and similar OS compared with preoperative chemotherapy.

AB - Objectives Although the use of neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma is increasing, the optimal preoperative treatment regimen remains poorly defined. Methods All patients with resectable pancreatic ductal adenocarcinoma who received preoperative chemotherapy alone (12%) or chemoradiation therapy (CRT) alone (88%) before pancreatectomy between 1999 and 2014 were included. Propensity score matching with inverse probability weighting was conducted based on age, baseline carbohydrate antigen 19-9, and procedure type. Results Patients who received preoperative CRT were more likely to undergo a margin negative (91% vs 79%, P < 0.01) and node negative (53% vs 23%, P < 0.01) resection and experience less locoregional recurrence (LR; 16% vs 33%, P < 0.01) but similar median overall survival (OS; 33.6 vs 26.4 months, P = 0.09). On multivariate analysis, carbohydrate antigen 19-9 (hazard ratio, 1.2; 95% confidence interval [CI], 1.1-1.3) and positive lymph nodes (hazard ratio, 1.5; 95% CI, 1.0-2.2) were associated with OS, whereas tumor size (odds ratio [OR], 1.5; 95% CI, 1.3-1.8), positive lymph nodes (OR, 3.1; 95% CI, 1.8-5.6), and preoperative chemotherapy (OR, 1.8; 95% CI, 1.1-2.9) were associated with LR. Conclusions Preoperative CRT is associated with less margin and lymph node positivity, reduced LR, and similar OS compared with preoperative chemotherapy.

KW - FOLFIRINOX

KW - neoadjuvant therapy

KW - pancreas cancer

KW - pancreatectomy

KW - whipple

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U2 - 10.1097/MPA.0000000000001231

DO - 10.1097/MPA.0000000000001231

M3 - Article

C2 - 30629022

AN - SCOPUS:85059915710

VL - 48

SP - 216

EP - 222

JO - Pancreas

JF - Pancreas

SN - 0885-3177

IS - 2

ER -