Neoadjuvant therapy is associated with lower margin positivity rates after Pancreaticoduodenectomy in T1 and T2 pancreatic head cancers: An analysis of the National Cancer Database

• Type of Material: Article
• Authors: Stephanie H Greco, Rutgers Cancer Institute of New Jersey; David A August, Rutgers Cancer Institute of New Jersey; Mihir Shah, Emory University; Chunxia Chen, Rutgers Cancer Institute of New Jersey; Dirk F Moore, Rutgers Cancer Institute of New Jersey; Monika Masanam, Rutgers Cancer Institute of New Jersey; Amber L Turner, Saint Barnabas Medical Center; Salma K Jabbour, Rutgers Cancer Institute of New Jersey; Parisa Javidian, Robert Wood Johnson University Hospital; Miral S Grandhi, Rutgers Cancer Institute of New Jersey; Timothy J Kennedy, Rutgers Cancer Institute of New Jersey; Richard H Alexander, Rutgers Cancer Institute of New Jersey; Darren R Carpizo, Rutgers Cancer Institute of New Jersey; Russell C Langan, Rutgers Cancer Institute of New Jersey
• Language: English
• Date: 2021-01-01
• Publisher: Emory University Libraries
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The Authors
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.sopen.2020.12.001
• Title of Journal or Parent Work: Surgery Open Science
• Volume: 3
• Start Page: 22
• End Page: 28
• Grant/Funding Information: None.
• Keywords: Surgical; Pathology; Pancreaticoduodenectomy
• Research Categories: Biology, Biostatistics; Biology, Radiation; Health Sciences, Medicine and Surgery

Abstract

Background: Neoadjuvant therapy (NAT) for T1/T2 pancreatic adenocarcinoma (PDAC) prior to pancreaticoduodenectomy remains controversial. We compared positive margin rates in patients with clinical T1&T2 tumors who did and did not receive NAT. Methods: The National Cancer Database (NCDB) found clinical T1&T2 PDAC patients who underwent pancreaticoduodenectomy from 2004 to 2014. Univariate and multivariate regression determined factors associated with a positive margin and survival. Results: 9795 patients underwent surgery for clinical T1 or T2 pancreatic head adenocarcinoma. 8472 patients had data regarding use of neoadjuvant and adjuvant therapies; of which, 774 (9.1%) received NAT and 435 (5.1%) received both chemotherapy and radiation therapy. NAT was found to lower positive margin rates from 21.8 to 15.5% (p < 0.0001) and when radiation was added this rate dropped to 13.4%. Positive margins were associated with worse overall survival (14.9 vs. 23.9 months; HR 1.702, p < 0.0001). Conclusions: NAT is associated with a reduced positive margin rate in patients with T1 and T2 tumors. These findings support ongoing and future clinical trials of NAT in T1 and T2, early stage PDAC to determine impacts on survival.