The effect of time to adjuvant chemotherapy on survival in nonmetastatic resectable pancreatic adenocarcinoma: A retrospective analysis.

Abstract

e14519 Background: The optimal timing for pancreatic cancer surgery to initiation of adjuvant chemotherapy (CT) is unknown. Most studies establish a maximum period of 56 days after surgery to treat patients in the adjuvant setting. We report a retrospective analysis to determine the relationship between time to adjuvant chemotherapy (TTAC) and survival. Methods: We retrospectively reviewed 29 consecutive patients with nonmetastatic resectable pancreatic adenocarcinoma who underwent curative surgery and adjuvant CT at our institution from January 2005 to December 2010. Our aim was to identify differences in PFS and OS depending on TTAC. We defined two groups of patients depending on TTAC: group A with TTAC ≤ 56 days and group B with TTAC > 56 days. Results: We identified 29 patients with resectable pancreatic adenocarcinoma who had undergone radical surgery and adjuvant CT with gemcitabine based on CONKO-001 phase III study. Nineteen were men and the median age was 61 years old (range 36-78). The median TTAC was 47 days (range 22-183). The most common reason for delaying adjuvant CT was post-operative complications. Seventeen patients initiated adjuvant CT within 56 days after surgery (group A). There were no significant statistic differences in age, gender, stage and palliative CT used at progression between the two groups. Median PFS and median OS in the whole group were 10.9 (95% CI 3.6-18.2) and 20.6 (95% CI 14.7-26.4) months respectively. Median OS was 26.4 months (95% CI 13.5-39.2) in group A and 14,8 months (95% CI 8.6-20.9) in group B. These differences were statistically significant (p value 0.015). No patient died of toxicity or post-operative complications. We could not find any significant statistic differences in median PFS between the two groups. Conclusions: This study demonstrates a higher risk of death in the group of patients who started adjuvant CT after 8 weeks of radical surgery for pancreatic adenocarcinoma. Nevertheless, no differences in PFS were found between the two groups. Theses findings indicate the need for clinicians and health systems managers to take the steps necessary to keep TTAC as short as reasonably achievable.