Multinational retrospective study of neoadjuvant therapy for left-sided resectable pancreatic cancer

Left-sided pancreatic cancer is associated with worse overall survival compared to right-sided disease. A retrospective study at 76 centers in 18 countries compared neoadjuvant therapy versus upfront surgery for left-sided resectable pancreatic cancer (RPC). The study included 2,282 patients, of whom 290 patients (13%) received neoadjuvant therapy. After upfront surgery, most patients (72%) received adjuvant chemotherapy. Neoadjuvant therapy was associated with prolonged OS compared to upfront surgery (adjusted HR 0.69; 95% CI 0.58-0.83) with an adjusted median OS of 53 versus 37 months and adjusted 5-year OS rates of 47% versus 35%. Interaction analysis demonstrated a stronger effect of neoadjuvant therapy in patients with a larger tumor and higher serum CA19-9; the effect of neoadjuvant therapy was not enhanced for splenic artery, splenic vein, retroperitoneal, and multivisceral involvement. The authors conclude that among patients with left-sided RPC, neoadjuvant therapy was associated with improved OS compared to upfront surgery.