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Response to Neoadjuvant Therapy and Prognosis in Patients with Resectable Pancreatic Cancer: A Propensity Score Matching Analysis

 Min Sung Yoon  ;  Hee Seung Lee  ;  Chang Moo Kang  ;  Woo Jung Lee  ;  Jiyoung Keum  ;  Min Je Sung  ;  Seung-Seob Kim  ;  Mi-Suk Park  ;  Jung Hyun Jo  ;  Moon Jae Chung  ;  Jeong Youp Park  ;  Seung Woo Park  ;  Si Young Song  ;  Ho Kyoung Hwang  ;  Seungmin Bang 
 GUT AND LIVER, Vol.16(1) : 118-128, 2022-01 
Journal Title
Issue Date
Antineoplastic Combined Chemotherapy Protocols / adverse effects ; Carcinoma, Pancreatic Ductal* / drug therapy ; Carcinoma, Pancreatic Ductal* / surgery ; Humans ; Neoadjuvant Therapy ; Pancreatectomy ; Pancreatic Neoplasms* / drug therapy ; Pancreatic Neoplasms* / surgery ; Prognosis ; Propensity Score
Neoadjuvant therapy ; Pancreatic neoplasm ; Progression-free survival ; Surgical outcome
Background/aims: : Controversy regarding the effectiveness of neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma (PDAC) still exists. Here, we aimed to identify the potential benefits of neoadjuvant therapy followed by surgery for resectable PDAC.

Methods: We reviewed radiologically resectable PDAC patients who received resection with curative intent at a tertiary hospital in South Korea between January 2012 and August 2019. A total of 202 patients underwent curative resection for resectable PDAC: 167 underwent surgical resection first during this period, and 35 received neoadjuvant chemotherapy/chemoradiation therapy followed by surgery. Resectable PDAC patients were subdivided, and 1:3 propensity score matching (PSM) was performed to reduce selection bias.

Results: Compared with the group that received surgery first, the group that received neoadjuvant treatment followed by surgery had significantly smaller tumors (22.0 mm vs 27.0 mm, p=0.004), a smaller proportion of patients with postoperative pathologic T stage (p=0.026), a smaller proportion of patients with lymphovascular invasion (20.0% vs 40.7%, p=0.022), and a larger proportion of patients with negative resection margins (74.3% vs 51.5%, p=0.049). After PSM, the group that received neoadjuvant therapy had a significantly longer progression-free survival than those in the group that underwent surgery first (29.6 months vs 15.1 months, p=0.002). Overall survival was not significantly different between the two groups after PSM analysis.

Conclusions: We observed significantly better surgical outcomes and progression-free survival with the addition of neoadjuvant therapy to the management of resectable PDAC. However, despite PSM, there was still selection bias due to the use of different regimens between the groups receiving surgery first and neoadjuvant therapy. Large homogeneous samples are needed in the future prospective studies.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
Keum, Jiyoung(금지영)
Kim, Seung-seob(김승섭) ORCID logo https://orcid.org/0000-0001-6071-306X
Park, Mi-Suk(박미숙) ORCID logo https://orcid.org/0000-0001-5817-2444
Park, Seung Woo(박승우) ORCID logo https://orcid.org/0000-0001-8230-964X
Park, Jeong Youp(박정엽) ORCID logo https://orcid.org/0000-0003-0110-8606
Bang, Seungmin(방승민) ORCID logo https://orcid.org/0000-0001-5209-8351
Sung, Min Je(성민제) ORCID logo https://orcid.org/0000-0001-5395-8851
Song, Si Young(송시영) ORCID logo https://orcid.org/0000-0002-1417-4314
Lee, Woo Jung(이우정) ORCID logo https://orcid.org/0000-0001-9273-261X
Lee, Hee Seung(이희승) ORCID logo https://orcid.org/0000-0002-2825-3160
Chung, Moon Jae(정문재) ORCID logo https://orcid.org/0000-0002-5920-8549
Jo, Jung Hyun(조중현) ORCID logo https://orcid.org/0000-0002-2641-8873
Hwang, Ho Kyoung(황호경) ORCID logo https://orcid.org/0000-0003-4064-7776
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