Role of Neoadjuvant Therapy for Patients with Adenosquamous Carcinoma of the Pancreas: Outcomes from the National Cancer Database

TL;DR

Neoadjuvant therapy before surgery improves survival for patients with a rare and aggressive type of pancreatic cancer called adenosquamous carcinoma.

Contribution

This study is the first to evaluate the impact of neoadjuvant therapy on outcomes for patients with pancreatic adenosquamous carcinoma using a large national database.

Findings

Patients who received neoadjuvant therapy had better overall survival compared to those who underwent surgery first.

Treatment at academic/research facilities and receipt of adjuvant therapy were also associated with improved survival.

There was no significant difference in survival between neoadjuvant chemotherapy alone and combined with radiation.

Abstract

Pancreatic adenosquamous carcinoma (PASC) is a rare and aggressive form of pancreatic cancer whose management often follows its more common pancreatic ductal adenocarcinoma (PDAC) counterpart. While neoadjuvant therapy (NT) is increasingly utilized prior to surgery for PDAC, whether patients with PASC experience similar benefits is unclear.

Using the National Cancer Database (NCDB), all patients with stage I-III PASC who underwent surgical resection between 2006 and 2020 were included. Patient and tumor characteristics and overall survival (OS) of patients who underwent surgery first (SF) were compared to those who received NT prior to surgery.

Among 1191 patients with PASC who underwent curative intent resection, 208 (17.5%) received NT, whereas 983 (82.5%) underwent SF. Overall, NT was associated with improved OS compared with an SF approach (median 20.7 vs 15.9 months; p = 0.03). On multivariable Cox regression analysis, factors independently associated with improved OS included treatment at an academic/research facility, receipt of NT, and receipt of adjuvant therapy. Factors associated with decreased OS included Black race, positive surgical margins, worse comorbidity score, and higher cancer stage. There was no significant difference in OS between patients who received NT chemotherapy and radiation vs NT chemotherapy alone.

Among patients with localized PASC, the receipt of NT prior to surgical resection was associated with improved OS outcomes. Future research is needed to clarify the optimal neoadjuvant treatment regimen, including the role of preoperative radiation, to enhance response to therapy and improve long-term outcomes.

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