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

2025; Elsevier BV; Linguagem: Inglês

10.1016/j.annonc.2024.12.015

1569-8041

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, Monique Ramaekers, Mark J. Truty, Martijn A. van Dam, Martijn W.J. Stommel, Marvin Petrikowski, Masafumi Imamura, M. Hayashi, Mathieu D’Hondt, Markus Brunner, M.E. Hogg, Chunmeng Zhang, Miguel Ángel Suárez Muñóz, Misha Luyer, Michiaki Unno, Masamichi Mizuma, M. Janot, M.A. Sahakyan, Nigel B. Jamieson, Olivier R. Busch, Orhan Bilge, Orlin Belyaev, Oskar Franklin, Patricia Sánchez‐Velázquez, P. Pessaux, Peter Strandberg Holka, Poya Ghorbani, Riccardo Casadei, Riccardo Sartoris, Richard D. Schulick, R. Grützmann, Robert Sutcliffe, Rodrigo Mata, Ragini Patel, Rei Takahashi, Salvador Rodriguez Franco, Santiago Sánchez-Cabús, Seitaro Hirano, Sébastien Gaujoux, S. Festen, Shingo Kozono, Shishir K. Maithel, Shuhui Chai, So Yamaki, Stijn van Laarhoven, J. Sven D. Mieog, Takeshi Murakami, Tatiana Codjia, Tetsuya Sumiyoshi, Tom M. Karsten, Toru Nakamura, Takeshi Sugawara, Ugo Boggi, V. Hartman, Vincent E. de Meijer, Wolf Bartholomä, Wooil Kwon, Ye Xin Koh, Young Jae Cho, Y. Takeyama, Yosuke Inoue, Yuichi Nagakawa, Yusuke Kawamoto, Yusuke Ome, Zahir Soonawalla, Kenichiro Uemura, Christopher L. Wolfgang, Jin‐Young Jang, Robert Padbury, Sohei Satoi, Wells A. Messersmith, Johanna W. Wilmink, Mohammad Abu Hilal, Marc G. Besselink, Marco Del Chiaro,

Renal cell carcinoma treatment

To assess the association between neoadjuvant therapy and overall survival (OS) in patients with left-sided resectable pancreatic cancer (RPC) compared to upfront surgery. 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. 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. 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 (Pinteraction=0.003) and higher serum CA19-9 (Pinteraction=0.005). In contrast, the effect of neoadjuvant therapy was not enhanced for splenic artery (Pinteraction=0.43), splenic vein (Pinteraction=0.30), retroperitoneal (Pinteraction=0.84), and multivisceral (Pinteraction=0.96) involvement. 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.