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

Sivesh K Kamarajah, Nikolaos Chatzizacharias, James Hodson, Francesca Marcon, Marit Kalisvaart, Pankaj Punia, Yuk Ting Ma, Bobby Dasari, Ravi Marudanayagam, Robert P Sutcliffe, Paolo Muiesan, Darius F Mirza, John Isaac, Keith J Roberts

Research output: Contribution to journalArticlepeer-review

103 Downloads (Pure)

Abstract

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.

Original languageEnglish
JournalANZ journal of surgery
Early online date12 Feb 2021
DOIs
Publication statusE-pub ahead of print - 12 Feb 2021

Keywords

  • Locally advanced
  • neoadjuvant
  • Pancreatic cancer
  • Survival

Fingerprint

Dive into the research topics of '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'. Together they form a unique fingerprint.

Cite this