M. A. Healy1, S. Shubeck1, W. Burns1, T. L. Frankel1, H. Nathan1 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA
Introduction: The benefit of neoadjuvant therapy for resectable pancreatic cancer (PanCa) is controversial, and its use varies significantly between centers. It is unknown whether neoadjuvant therapy practices are associated with short- and long-term patient outcomes across institutions. We sought to evaluate whether institutions that routinely use neoadjuvant therapy achieve superior aggregate outcomes for PanCa patients.
Methods: Using the National Cancer Data Base Participant User File, we identified patients with non-metastatic T1-2 PanCa diagnosed from 2006-2013. Hospitals were stratified into quintiles based on risk- and reliability-adjusted rates of neoadjuvant therapy use in resected patients (including chemotherapy and/or radiation). Post-operative and survival outcomes were compared between hospitals using neoadjuvant therapy frequently (Neo-Hi) vs infrequently (Neo-Lo).
Results: We identified 20,646 patients with median age 72 years and 25% T1 tumors. Among 815 treating hospitals, adjusted rates of neoadjuvant therapy varied almost 30-fold (2.9%-83%). Patients at Neo-Hi vs Neo-Lo hospitals had higher readmission rates (8.8% vs 7.4%; P<0.01) but similar 30-day mortality (6.0% vs 5.8%;P=0.6). Neo-Hi vs Neo-Lo hospitals had lower surgical margin positivity (17% vs 21%; P<0.001) and node positivity (56% vs 63%; P<0.001). Resected patients at Neo-Hi vs Neo-Lo hospitals had marginally improved adjusted overall survival at 2 years (48% vs 51%) but not at 5 years (22% vs 22%) (overall HR 0.92, P<0.05). When patients who received systemic therapy but did not ultimately undergo resection were included, there was also no difference in survival (HR 0.98, P=0.3).
Conclusion: Hospitals that use neoadjuvant therapy more frequently in T1-2 PanCa demonstrate lower rates of nodal and margin positivity in resected patients. When patients receiving systemic therapy without ultimately undergoing resection are included, there is no survival difference across hospitals, although these patients may be spared surgical morbidity. Institutional practices regarding neoadjuvant therapy for PanCa do not result in improved aggregate outcomes.
