Abstract
BackgroundPancreatic ductal adenocarcinoma (PDAC) is a highly aggressive tumor showing a tendency for early recurrence, even after curative resection. Although adjuvant treatment improves survival, it is unclear whether early adjuvant treatment initiation yields better outcomes in patients with PDAC.MethodsWe retrospectively enrolled 113 patients who underwent chemotherapy or chemoradiotherapy after curative resection of PDAC: Fifty-six and 57 patients were in the early and delayed groups, respectively based on the median time of treatment initiation (35 days [range, 20–83 days]).ResultsPatient baseline characteristics were comparable in both groups, except for grade III or IV postoperative complications (5.4% in the early group vs. 22.8% in the delayed group). With a median 20.3-month follow-up, the overall survival (OS) and disease-free survival (DFS) times were 29.5 and 14.7 months, respectively. The early group had significantly prolonged OS (39.1 vs. 21.1 months, p = 0.018) and DFS (18.8 vs. 10.0 months, p = 0.034), compared to the delayed group. Among 71 patients who completed planned adjuvant treatment, patients in the early group tended to have longer, though not statistically significant, OS and DFS times than those in the delayed group. In 67 patients without postoperative complications, patients in the early group had longer OS (42.8 vs. 20.5 months, p = 0.002) and DFS (19.6 vs. 9.1 months, p = 0.005) than those in the delayed group. By multivariate analysis, incompletion of treatment (hazard ratio [HR]: 4.039, 95% confidence interval [CI]: 2.334–6.992), delayed treatment initiation (HR: 1.822, 95% CI: 1.081–3.070), and positive angiolymphatic invasion (HR: 2.116, 95% CI: 1.160–3.862) were significantly associated with shorter OS.ConclusionsAdjuvant treatment should be delivered earlier and completed for better outcomes in resected PDAC patients, especially without postoperative complications.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) is one of the most fatal solid tumors, with a 5-year survival rate of less than 6% [1, 2]
Incompletion of treatment, delayed treatment initiation (HR: 1.822, 95% CI: 1.081–3.070), and positive angiolymphatic invasion (HR: 2.116, 95% CI: 1.160–3.862) were significantly associated with shorter overall survival (OS)
The National Comprehensive Cancer Network (NCCN) guidelines state that chemotherapy should be initiated for all patients who underwent curative resection, but they do not specify the optimal start time for chemotherapy or whether it should be delayed until full recovery [19]
Summary
Pancreatic ductal adenocarcinoma (PDAC) is one of the most fatal solid tumors, with a 5-year survival rate of less than 6% [1, 2]. The appropriate time to initiate adjuvant treatment, considering patient’ safety, compliance and effectiveness, has not been well described in PDAC patients to date. There is evidence that early adjuvant treatment initiation leads to superior survival rates for patients with breast [13, 14], colorectal [15,16,17], and pancreatic cancer [12, 18]. The National Comprehensive Cancer Network (NCCN) guidelines state that chemotherapy should be initiated for all patients who underwent curative resection, but they do not specify the optimal start time for chemotherapy or whether it should be delayed until full recovery [19].
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