Nationwide trends and outcomes of neoadjuvant chemotherapy in pancreatic cancer – an analysis of the Swedish national pancreatic cancer registry

Abstract

Objectives

During the last decade, neoadjuvant therapy (NAT) for pancreatic cancer has become more frequent. Pathological response and overall survival are promising; however, various post-operative complications have been reported. Our primary aim was to compare the complication scenario of patients receiving NAT in borderline resectable and locally advanced disease with those who had upfront pancreatic surgery (UFS) for primarily resectable cancer.

Methods

From the Swedish National Pancreatic and Periampullary Cancer Registry, patients resected for pancreatic ductal adenocarcinoma (PDAC) between 2010 and 2018 were identified. Data on patient characteristics, neoadjuvant therapy, post-operative complications and survival were obtained. Comparisons between groups as well as survival analysis were performed.

Results

Within the total cohort of 13,948 patients, 1894 (median age 69 years, 51% men) were resected for PDAC. Among these, 112 (5.9%) patients received NAT followed by surgery. The patients who received NAT were younger (67 vs 70 years, p < .001), had a lower level of CA19-9 (47 vs 108, p = .001) and had to a larger extent vascular resection (58.9 vs 26.9%, p < .001) and total pancreatectomy performed (23.2 vs 9.1%, p < .001). No difference was found for major post-operative complications and there was no significant change in survival rate between the NAT and UFS groups (median 28 vs 26 months, p = .122).

Conclusions

When analyzing data from a national registry, no difference in post-operative complications was found between resected patients receiving UFS and NAT for PDAC. Also, the survival was equal between groups. NAT is a feasible treatment option for patients with potentially curable pancreatic cancer.

Keywords:

• Pancreatic cancer
• borderline resectable
• neoadjuvant therapy
• pancreatic cancer surgery
• resection
• complications

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data underlying this study will be shared upon reasonable request to the corresponding author.

Additional information

Funding

This research was supported by the Swedish Cancer Foundation and Maggie Stevens Foundation.