Is early-stage pancreatic adenocarcinoma truly early: stage migration on final pathology with surgery-first versus neoadjuvant therapy sequencing

HPB : the Official Journal of the International Hepato Pancreato Biliary Association
Andrew J LeeChing-Wei David Tzeng

Abstract

Neoadjuvant therapy (NT) remains controversial in early-stage pancreatic ductal adenocarcinoma (PDAC), defined as clinical (c)Stage I-II. Our aim was to analyze rates of pathologic upstaging/downstaging for resectable PDAC treated with surgery-first (SF) vs. NT. Utilizing the National Cancer Data Base (NCDB), patients with cStage I-II PDAC who underwent pancreatoduodenectomy in 2006-2013 were pathologically staged using the AJCC 8th edition and compared by treatment sequencing. Among 13,871 patients, 15.3% received NT. Despite higher pre-treatment T-stage (cT2: 71.9% vs. 56.3%, p < 0.001), NT patients had lower rates of pathologic nodal metastases (46.2% vs. 69.2% in SF, p < 0.001), suggesting higher rates of pathologic downstaging. In cStage II, 33.0% were upstaged to stage III after SF, vs. only 14.0% after NT. In cStage I, 65.5% were upstaged following SF, vs. 46.7% after NT (all p < 0.001). Patients with NT (HR-0.77, p < 0.001) or downstaging (HR-0.80, p < 0.001) had improved overall survival (OS). NT is associated with reduction in unexpected upstaging, reduction in nodal positivity, and improved OS, compared to SF approach in putatively early-stage PDAC. Because clinical staging underestimates the underlying disease burde...Continue Reading

Citations

Sep 27, 2020·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·Tomoyuki AbeToshio Noriyuki
Mar 7, 2021·Journal of Clinical Medicine·Hyung Sun KimDong Sup Yoon
Apr 10, 2021·Journal of Surgical Oncology·Elizabeth J OleckiNiraj J Gusani
Jan 4, 2021·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Stacey KirkpatrickSteven J Hughes
May 25, 2021·Annals of Surgical Oncology·Asmita ChopraJoal D Beane
Nov 3, 2020·American Journal of Surgery·Felipe B MaegawaIoannis T Konstantinidis
Jun 25, 2021·World Journal of Gastrointestinal Oncology·Muhammad Shehroz Zeeshan, Zeeshan Ramzan

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