The impact of neoadjuvant therapy in patients with left-sided resectable pancreatic cancer: an international multicenter study
Elena Rangelova, Thomas F. Stoop, Tess M. E. van Ramshorst, Mahsoem Ali, Eduard A. van Bodegraven, Ammar A. Javed, Daisuke Hashimoto, E. Steyerberg, A. Banerjee, Apurva Jain, Alain Sauvanet, Alejandro Serrablo, Alessandro Giani, Alessandro Giardino, Alessandro Zerbi, Ali Arshad, Allard G Wijma, Andrea Coratti, Andrea Zironda, Andreas Socratous, Aram Rojas, A. Halimi, Aslam Ejaz, Atsushi Oba, B.Y. Patel, Bergþór Björnsson, Bradley N. Reames, Bobby Tingstedt, Brian K. P. Goh, Carmen Payá‐Llorente, Carlos Domingo del Pozo, C. González-Abós, C. Medin, Casper H.J. van Eijck, Charles de Ponthaud, Chie Takishita, Christoph Schwabl, C. Månsson, Claudio Ricci, Cornelius A. Thiels, Daisuke Douchi, D L Hughes, David Kilburn, D Flanking, Dyre Kleive, Donzília Sousa Silva, Barish H. Edil, Elizabeth Pando, Els Moltzer, Emanuele F. Kauffmann, Edus H. Warren, Emre Bozkurt, Ernesto Sparrelid, Elizabeth Thoma, Eva M M Verkolf, F. Ausania, Fabio Giannone, Felix J. Hüttner, Fernando Burdı́o, Régis Souche, Frederik Berrevoet, Freek Daams, Fuyuhiko Motoi, Gabriel Saliba, G. Kazemier, G. Roeyen, G. Nappo, Giovanni Butturini, Giovanni Ferrari, G Kito Fusai, Goro Honda, Gregory Sergeant, Hedvig Karteszi, Hideki Takami, Hironobu Suto, I. Matsumoto, Isabel Mora, Isabella Frigerio, J Fabré, Jie Chen, Jonathan G. Sham, José Davide, Jozef Urdzik, Julien de Martino, Kirsten Marie Nielsen, Keiichi Okano, Keiko Kamei, Ken‐ichi Okada, Kimitaka Tanaka, Knut Jørgen Labori, Kristin E. Goodsell, Laura Alberici, Laurence Webber, Luben Kirkov, Luca Franco, M. Miyashita, Manuel Maglione, Marco Gramellini, Marco Ramera, Maria João Amaral
Abstract
BACKGROUND: Left-sided pancreatic cancer is associated with worse overall survival (OS) compared with right-sided pancreatic cancer. Although neoadjuvant therapy is currently seen as not effective in patients with resectable pancreatic cancer (RPC), current randomized trials included mostly patients with right-sided RPC. The purpose of this study was to assess the association between neoadjuvant therapy and OS in patients with left-sided RPC compared with upfront surgery. PATIENTS AND METHODS: This was an international multicenter retrospective study including consecutive patients after left-sided pancreatic resection for pathology-proven RPC, either after neoadjuvant therapy or upfront surgery in 76 centers from 18 countries on 4 continents (2013-2019). The primary endpoint was OS from diagnosis. Time-dependent Cox regression analysis was carried out to investigate the association of neoadjuvant therapy with OS, adjusting for confounders at the time of diagnosis. Adjusted OS probabilities were calculated. RESULTS: = 0.96) involvement. CONCLUSIONS: Neoadjuvant therapy in patients with left-sided RPC was associated with improved OS compared with upfront surgery. The impact of neoadjuvant therapy increased with larger tumor size and higher serum CA19-9 at diagnosis. Randomized controlled trials on neoadjuvant therapy specifically in patients with left-sided RPC are needed.