The impact of neoadjuvant therapy in patients with left-sided resectable pancreatic cancer: an international multicenter study.

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Autores de FISABIO

Autores ajenos a FISABIO

  • Rangelova E
  • Stoop TF
  • van Ramshorst TME
  • Ali M
  • van Bodegraven EA
  • Javed AA
  • Hashimoto D
  • Steyerberg E
  • Banerjee A
  • Jain A
  • Sauvanet A
  • Serrablo A
  • Giani A
  • Giardino A
  • Zerbi A
  • Arshad A
  • Wijma AG
  • Coratti A
  • Zironda A
  • Socratous A
  • Rojas A
  • Halimi A
  • Ejaz A
  • Oba A
  • Patel BY
  • Björnsson B
  • Reames BN
  • Tingstedt B
  • Goh BKP
  • González-Abós C
  • Medin C
  • van Eijck CHJ
  • de Ponthaud C
  • Takishita C
  • Schwabl C
  • Månsson C
  • Ricci C
  • Thiels CA
  • Douchi D
  • Hughes DL
  • Kilburn D
  • Flanking D
  • Kleive D
  • Sousa Silva D
  • Edil BH
  • Pando E
  • Moltzer E
  • Kauffman EF
  • Warren E
  • Bozkurt E
  • Sparrelid E
  • Thoma E
  • Verkolf E
  • Ausania F
  • Giannone F
  • Hüttner FJ
  • Burdio F
  • Souche FR
  • Berrevoet F
  • Daams F
  • Motoi F
  • Saliba G
  • Kazemier G
  • Roeyen G
  • Nappo G
  • Butturini G
  • Ferrari G
  • Kito Fusai G
  • Honda G
  • Sergeant G
  • Karteszi H
  • Takami H
  • Suto H
  • Matsumoto I
  • Mora-Oliver I
  • Frigerio I
  • Fabre JM
  • Chen J
  • Sham JG
  • Davide J
  • Urdzik J
  • de Martino J
  • Nielsen K
  • Okano K
  • Kamei K
  • Okada K
  • Tanaka K
  • Labori KJ
  • Goodsell KE
  • Alberici L
  • Webber L
  • Kirkov L
  • de Franco L
  • Miyashita M
  • Maglione M
  • Gramellini M
  • Ramera M
  • João Amaral M
  • Ramaekers M
  • Truty MJ
  • van Dam MA
  • Stommel MWJ
  • Petrikowski M
  • Imamura M
  • Hayashi M
  • D'Hondt M
  • Brunner M
  • Hogg ME
  • Zhang C
  • Ángel Suárez-Muñoz M
  • Luyer MD
  • Unno M
  • Mizuma M
  • Janot M
  • Sahakyan MA
  • Jamieson NB
  • Busch OR
  • Bilge O
  • Belyaev O
  • Franklin O
  • Sánchez-Velázquez P
  • Pessaux P
  • Strandberg Holka P
  • Ghorbani P
  • Casadei R
  • Sartoris R
  • Schulick RD
  • Grützmann R
  • Sutcliffe R
  • Mata R
  • Patel RB
  • Takahashi R
  • Rodriguez Franco S
  • Sánchez Cabús S
  • Hirano S
  • Gaujoux S
  • Festen S
  • Kozono S
  • Maithel SK
  • Chai SM
  • Yamaki S
  • van Laarhoven S
  • Mieog JSD
  • Murakami T
  • Codjia T
  • Sumiyoshi T
  • Karsten TM
  • Nakamura T
  • Sugawara T
  • Boggi U
  • Hartman V
  • de Meijer VE
  • Bartholomä W
  • Kwon W
  • Koh YX
  • Cho Y
  • Takeyama Y
  • Inoue Y
  • Nagakawa Y
  • Kawamoto Y
  • Ome Y
  • Soonawalla Z
  • Uemura K
  • Wolfgang CL
  • Jang JY
  • Padbury R
  • Satoi S
  • Messersmith W
  • Wilmink JW
  • Abu Hilal M
  • Besselink MG
  • Del Chiaro M
  • European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS) and the I

Grupos de Investigación

Abstract

PURPOSE: To assess the association between neoadjuvant therapy and overall survival (OS) in patients with left-sided resectable pancreatic cancer (RPC) compared to upfront surgery. BACKGROUND: Left-sided pancreatic cancer is associated with worse OS compared to right-sided pancreatic cancer. Although neoadjuvant therapy is currently seen as not effective in patients with RPC, current randomized trials included mostly patients with right-sided RPC. METHODS: 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). Primary endpoint is OS from diagnosis. Time-dependent Cox regression analysis was performed to investigate the association of neoadjuvant therapy with OS, adjusting for confounders at time of diagnosis. Adjusted OS probabilities were calculated. RESULTS: Overall, 2,282 patients after left-sided pancreatic resection for RPC were included of whom 290 patients (13%) received neoadjuvant therapy. The most common neoadjuvant regimens were (m)FOLFIRINOX (38%) and gemcitabine-nab-paclitaxel (22%). After upfront surgery, 72% of patients received adjuvant chemotherapy, mostly a single-agent regimen (74%). Neoadjuvant therapy was associated with prolonged OS compared to upfront surgery (adjusted HR=0.69 [95%CI 0.58-0.83]) with an adjusted median OS of 53 vs. 37 months (P=0.0003) and adjusted 5-year OS rates of 47% vs. 35% (P=0.0001) compared to upfront surgery. Interaction analysis demonstrated a stronger effect of neoadjuvant therapy in patients with a larger tumor (P(interaction)=0.003) and higher serum CA19-9 (P(interaction)=0.005). In contrast, the effect of neoadjuvant therapy was not enhanced for splenic artery (P(interaction)=0.43), splenic vein (P(interaction)=0.30), retroperitoneal (P(interaction)=0.84), and multivisceral (P(interaction)=0.96) involvement. CONCLUSIONS: Neoadjuvant therapy in patients with left-sided RPC was associated with improved OS compared to 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.

Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Datos de la publicación

ISSN/ISSNe:
0923-7534, 1569-8041

ANNALS OF ONCOLOGY  OXFORD UNIV PRESS

Tipo:
Article
Páginas:
529-542
PubMed:
39814200

Citas Recibidas en Web of Science: 4

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Keywords

  • CA19.9; multivisceral involvement; neoadjuvant therapy; pancreatic adenocarcinoma; pancreatic body/tail; resectable; splenic artery; splenic vein; tumor size

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