Optimal timing and predictors of adjuvant therapy in patients with poorly differentiated pancreatic adenocarcinoma Open Access
Shah, Mihir (Summer 2025)
Abstract
Background: Multimodal therapy, combining chemotherapy and surgical resection, is the standard of care for patients with resectable Pancreatic Ductal Adenocarcinoma (PDAC). Patients with poorly differentiated PDAC have suboptimal overall survival (OS), partly due to the limited understanding of optimal timing for return to intended oncologic therapy (RIOT) after upfront surgery. This thesis evaluates patients with poorly differentiated PDAC who undergo upfront surgical resection and assess how the timing of receipt of adjuvant chemotherapy is associated with OS.
Methods: Using the National Cancer Database, we identified poorly differentiated non-metastatic PDAC patients who received upfront surgical resection followed by adjuvant chemotherapy (2007-2016). Adjusted Cox proportional hazard models evaluated OS based on RIOT timing. Logistic regression was used to identify factors associated with RIOT.
Results: Of 3,050 included patients, 66.1% (n=1,810) did RIOT within 9 weeks and 33.9% (n=927) after 9 weeks. The median age of the study cohort was 62 years; 52% (n = 1,583) were male and 87.1% (n = 2,657) were White. Adjusted multivariable analysis (age, race, facility type, insurance status, Charlson-Deyo score, income, education, year of diagnosis, pathological T & N stage and margins) noted that patients who did RIOT within 9 weeks were associated with improved OS compared to patients who did RIOT after 9 weeks (aHR 0.90, 95%CI 0.82-0.99, p=0.03). Treatment at academic facilities was associated with lower odds of RIOT within 9 weeks compared to treatment at non-academic facilities (aOR 0.83, 95%CI 0.70-0.98, p=0.03).
Conclusion: Patients with poorly differentiated pancreatic ductal adenocarcinoma may benefit from adjuvant therapy within 9 weeks after surgical resection. Opportunities may exist in academic facilities to facilitate adjuvant therapy within 9 weeks of surgical resection.
Table of Contents
TABLE OF CONTENTS
1. Background
2. Methods
2.1 Study Design
2.2 Study Patients
2.3 Variables and Comparison Groups
2.4 Statistical Analysis
3. Results
3.1 Patient Demographics and Tumor Characteristics
3.2 Demographic and Tumor Characteristics associated with Overall Survival
3.3 Demographic and Tumor Characteristics associated with RIOT (< 9 weeks)
4. Discussion
5. References
6. Figures
Figure 1. Stages of Pancreatic Ductal Adenocarcinoma (A) Resectable (B) Borderline-resectable (C) Locally advanced (D) Oligometastatic (E) Metastatic (adapted with permission from Springfield et al.).33
Figure 2. Schematic depicting inclusion and exclusion criteria of patients with pancreatic ductal adenocarcinoma
7. Tables
Table 1. Descriptive Statistics
Table 2. Factors associated with overall survival based on univariate Cox regression analysis
Table 3. Factors associated with overall survival based on multivariable Cox regression analysis
Table 4. Factors associated with RIOT within 9 weeks based on univariate logistic regression analysis
Table 5. Factors associated with RIOT within 9 weeks based on multivariable logistic regression analysis
8. Supplementary Tables
Supplementary Table 1. Topographic descriptions for Pancreatic Neoplasms and ICD-O-3 Codes
Supplementary Table 2. Cox Proportional Hazard Regression Analyses Exploring OS based on Different Timing of Return to Intended Oncologic Therapy (RIOT)
About this Master's Thesis
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