Response to Neoadjuvant Therapy and Prognosis in Patients with Resectable Pancreatic Cancer: A Propensity Score Matching Analysis
Min Sung Yoon,
Hee Seung Lee,
Chang Moo Kang,
Woo Jung Lee,
Jiyoung Keum,
Min Je Sung,
Seung-seob Kim,
Mi-Suk Park,
Jung Hyun Jo,
Moon Jae Chung,
Jeong Youp Park,
Seung Woo Park,
Si Young Song,
Ho Kyoung Hwang,
Seungmin Bang
Affiliations
Min Sung Yoon
Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Hee Seung Lee
Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Chang Moo Kang
Division of Gastroenterology, Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Korea
Woo Jung Lee
Division of Gastroenterology, Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Korea
Jiyoung Keum
Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Min Je Sung
Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Seung-seob Kim
Division of Gastroenterology, Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Mi-Suk Park
Division of Gastroenterology, Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Jung Hyun Jo
Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Moon Jae Chung
Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Jeong Youp Park
Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Seung Woo Park
Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Si Young Song
Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Ho Kyoung Hwang
Division of Gastroenterology, Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Korea
Seungmin Bang
Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Background/Aims: Controversy regarding the effectiveness of neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma (PDAC) still exists. Here, we aimed to identify the potential benefits of neoadjuvant therapy followed by surgery for resectable PDAC. Methods: We reviewed radiologically resectable PDAC patients who received resection with curative intent at a tertiary hospital in South Korea between January 2012 and August 2019. A total of 202 patients underwent curative resection for resectable PDAC: 167 underwent surgical resection first during this period, and 35 received neoadjuvant chemotherapy/chemoradiation therapy followed by surgery. Resectable PDAC patients were subdivided, and 1:3 propensity score matching (PSM) was performed to reduce selection bias. Results: Compared with the group that received surgery first, the group that received neoadjuvant treatment followed by surgery had significantly smaller tumors (22.0 mm vs 27.0 mm, p=0.004), a smaller proportion of patients with postoperative pathologic T stage (p=0.026), a smaller proportion of patients with lymphovascular invasion (20.0% vs 40.7%, p=0.022), and a larger proportion of patients with negative resection margins (74.3% vs 51.5%, p=0.049). After PSM, the group that received neoadjuvant therapy had a significantly longer progression-free survival than those in the group that underwent surgery first (29.6 months vs 15.1 months, p=0.002). Overall survival was not significantly different between the two groups after PSM analysis. Conclusions: We observed significantly better surgical outcomes and progression-free survival with the addition of neoadjuvant therapy to the management of resectable PDAC. However, despite PSM, there was still selection bias due to the use of different regimens between the groups receiving surgery first and neoadjuvant therapy. Large homogeneous samples are needed in the future prospective studies.
