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

Stephanie H Greco; David A August; Mihir M Shah; Chunxia Chen; Dirk F Moore; Monika Masanam; Amber L Turner; Salma K Jabbour; Parisa Javidian; Miral S Grandhi; Timothy J Kennedy; H Richard Alexander; Darren R Carpizo; Russell C Langan

doi:10.1016/j.sopen.2020.12.001

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

Surg Open Sci. 2020 Dec 16:3:22-28. doi: 10.1016/j.sopen.2020.12.001. eCollection 2021 Jan.

Authors

Stephanie H Greco^{1

2}, David A August^{1

2

3}, Mihir M Shah⁴, Chunxia Chen⁵, Dirk F Moore⁵, Monika Masanam¹, Amber L Turner³, Salma K Jabbour⁶, Parisa Javidian⁷, Miral S Grandhi^{1

2

3}, Timothy J Kennedy^{1

2

3}, H Richard Alexander^{1

2

3}, Darren R Carpizo^{1

2

3}, Russell C Langan^{1

2

3}

Affiliations

¹ Gastrointestinal and Hepatobiliary Oncology, Rutgers Cancer Institute of New, Jersey.
² Department of Surgery, Rutgers Robert Wood Johnson University Medical School.
³ Department of Surgery, RWJBarnabas Health, Saint Barnabas Medical Center.
⁴ Division of Surgical Oncology, Department of Surgery, Emory University.
⁵ Biostatistics, Rutgers Cancer Institute of New, Jersey.
⁶ Division of Radiation Oncology, Rutgers Cancer Institute of New, Jersey.
⁷ Department of Pathology, Rutgers Robert Wood Johnson University Hospital.

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.

Grants and funding

R50 CA275877/CA/NCI NIH HHS/United States