Impact of adjuvant chemotherapy on resected intraductal papillary mucinous neoplasm-derived pancreatic cancer: Results from an international multicenter study Journal Article
| Authors: | Habib, J. R.; Kinny-Köster, B.; Javed, A. A.; Zelga, P.; Saadat, L. V.; Kim, R. C.; Gorris, M.; Allegrini, V.; Watanabe, S.; Sharib, J.; Arcerito, M.; Kaiser, J.; Lafaro, K. J.; Tu, M.; Bhandre, M.; Shi, C.; Kim, M. P.; Correa, C.; Daamen, L. A.; Oberstein, P. E.; Schmidt, C. M.; Hanna, N. N.; Allen, P.; Loos, M.; Shrikhande, S. V.; Molenaar, I. Q.; Frigerio, I.; Katz, M. H. G.; Soares, K. C.; Miao, Y.; Del Chiaro, M.; He, J.; Hackert, T.; Salvia, R.; Büchler, M. W.; Castillo, C. F. D.; Besselink, M. G.; Marchegiani, G.; Wolfgang, C. L.; for the Verona IPMN Consortium |
| Article Title: | Impact of adjuvant chemotherapy on resected intraductal papillary mucinous neoplasm-derived pancreatic cancer: Results from an international multicenter study |
| Abstract: | PURPOSEThe benefit of adjuvant therapy for intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) remains unclear because of severely limited evidence. Although biologically distinct entities, adjuvant therapy practices for IPMN-derived PDAC are largely founded on pancreatic intraepithelial neoplasia-derived PDAC. We aimed to evaluate the role of adjuvant chemotherapy in IPMN-derived PDAC.METHODSThis international multicenter retrospective cohort study (2005-2018) was conceived at the Verona Evidence-Based Medicine meeting. Cox regressions were performed to identify risk-adjusted hazard ratios (HR) associated with overall survival (OS). Kaplan-Meier curves and log-rank tests were employed for survival analysis. Logistic regression was performed to identify factors motivating adjuvant chemotherapy administration. A decision tree was proposed and categorized patients into overtreated, undertreated, and optimally treated cohorts.RESULTSIn 1,031 patients from 16 centers, nodal disease (HR, 2.88, P <.001) and elevated (≥37 to <200 μ/mL, HR, 1.44, P =.006) or markedly elevated (≥200 μ/mL, HR, 2.53, P <.001) carbohydrate antigen 19-9 (CA19-9) were associated with worse OS. Node-positive patients with elevated CA19-9 had an associated 34.4-month improvement in median OS (P =.047) after adjuvant chemotherapy while those with positive nodes and markedly elevated CA19-9 had an associated 12.6-month survival benefit (P <.001). Node-negative patients, regardless of CA19-9, did not have an associated benefit from adjuvant chemotherapy (all P >.05). Based on this model, we observed undertreatment in 18.1% and overtreatment in 61.2% of patients. Factors associated with chemotherapy administration included younger age, R1-margin, poorer differentiation, and nodal disease.CONCLUSIONAlmost half of patients with resected IPMN-derived PDAC may be overtreated or undertreated. In patients with node-negative disease or normal CA19-9, adjuvant chemotherapy is not associated with a survival benefit, whereas those with node-positive disease and elevated CA19-9 have an associated benefit from adjuvant chemotherapy. A decision tree was proposed. Randomized controlled trials are needed for validation. © 2024 American Society of Clinical Oncology. |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 42 |
| Issue: | 36 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2024-12-20 |
| Start Page: | 4317 |
| End Page: | 4326 |
| Language: | English |
| DOI: | 10.1200/jco.23.02313 |
| PUBMED: | 39255450 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Source: Scopus |
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