The survival effect of neoadjuvant therapy and neoadjuvant plus adjuvant therapy on pancreatic ductal adenocarcinoma patients with different TNM stages: a propensity score matching analysis based on the SEER database

ABSTRACT

Background

Adjuvant therapy (AT) and neoadjuvant therapy (NAT) are standard treatments for pancreatic ductal adenocarcinoma (PDAC) depending on the status of the disease. However, whether AT improves survival after NAT and radical resection in all TNM stages remains unclear.

Research design and methods

We utilized the Surveillance, Epidemiology, and End Results (SEER) database (2010–2019) for PDAC patients who underwent radical surgery and applied Pearson’s chi-square test, multivariate and univariate Cox regression, Kaplan-Meier plot, Log-rank tests, and propensity score matching (PSM) for analysis.

Results

Given PSM after enrolling 13,868 PDAC patients, significant differences in survival were identified between AT and neoadjuvant therapy plus adjuvant therapy (NATAT) (p = 0.023) as well as between NAT and NATAT (p < 0.001). According to the AJCC 8th TNM stage, a survival advantage associated with NATAT was exclusively observed in stage III and IV disease, except for T4N0M0. Some stage IV patients receiving NATAT exhibited comparable survival to their counterparts without metastasis.

Conclusions

In this retrospective cohort study, we demonstrated that patients harboring tumors in late TNM stages, including N2 resectable PDAC, might have better survival from NATAT, and that certain patients with M1 disease might still benefit from comprehensive systemic therapy and radical resection.

KEYWORDS:

• Adjuvant therapy
• neoadjuvant therapy
• overall survival
• pancreatic ductal adenocarcinoma
• propensity score matching
• surveillance epidemiology and end results

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

We thank the SEER program for providing the data.

Authors’ contributions

Z Wu – project administration, conceptualization, methodology, data analysis, manuscript revision, and accountability revision; H Hu – writing of original draft & editing, visualization, validation, software, methodology, formal analysis, data curation; Y Xu – validation, resources, data curation; Q Zhang and Y Gao – article research, writing review & editing.

Data availability statement

The data from this study are publicly available in the National Cancer Institute’s SEER database at https://seer.cancer.gov/.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737140.2024.2347513

Additional information

Funding

This paper was not funded.