Is adjuvant chemotherapy associated with improved survival for patients with a complete pathological response to neoadjuvant chemotherapy for pancreatic adenocarcinoma?: A population-based analysis.

Abstract

e16453 Background: The treatment for localized pancreatic adenocarcinoma often involves neoadjuvant chemotherapy and surgical resection followed by adjuvant chemotherapy. In the case of a complete pathologic response (pCR) with node-negative disease, it is unclear if adjuvant chemotherapy improves survival. This study aims to identify whether adjuvant therapy for patients with a pCR is associated with improved survival. Methods: This study utilizes the 2004-2022 National Cancer Database participant user file on pancreatic cancers. Patients were selected for a histological diagnosis of pancreatic adenocarcinoma, age ≥18 years, treated with neoadjuvant chemotherapy and underwent either a pancreaticoduodenectomy or distal pancreatectomy. Patients were excluded if they had a Charlson-Dayo score greater than 2, AJCC staging greater than ypT0, treated with either hormone or immune therapy, or died within 90 days of surgery. IBM SPSS was used to create two cohorts, those that received adjuvant therapy and those that did not. SPSS was used for Kaplan Meier analysis to compare the survival and follow-up between the two groups and log-rank analysis to illicit significance. Results: Out of 9748 patients, a total of 508 patients had a pCR (5.5%). In the adjuvant cohort (n = 109), the 5-year survival was 58.6% and the 10-year survival was 34.3%. In the no therapy cohort (n = 399), the 5-year survival was 58.1% and the 10-year survival was 38.3%. The median survival of the adjuvant cohort was 94.720 ± 23.241 months, and the median survival of the no therapy cohort was 78.260 ± 8.856 months. Log rank analysis yielded a p-value of .865. The median follow-up of the adjuvant therapy cohort was 61.630 ± 5.907 months, and the median survival of the no therapy cohort was 54.800 ± 1.826 months. Log rank analysis yielded a p-value of .298. Conclusions: For patients who had a pCR after neoadjuvant chemotherapy for pancreatic adenocarcinoma, adjuvant chemotherapy is not associated with an improvement in survival.