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Background <p>Increased application of neoadjuvant therapy (NAT) and adjuvant therapy (AT) could limit treatment options for pancreatic ductal adenocarcinoma (PDAC) recurrence. This study aimed to identify patterns of recurrence-focused treatment and survival following different primary treatment strategies.</p> Methods <p>All patients who underwent PDAC resection in the Netherlands (2014–2019) were included. Patients were divided into five groups according to their primary treatment strategy: (1) resection only, (2) gemcitabine-based NAT + resection, (3) FOLFIRINOX-based NAT + resection, (4) resection + gemcitabine-based AT, and (5) resection + FOLFIRINOX-based AT. Differences in recurrence-focused treatment and post-recurrence survival (PRS) were assessed using multivariable logistic and Cox-proportional hazards analyses and were presented as odds ratios (ORs) and hazard ratios (HRs) with corresponding 95% confidence intervals (95% CIs), respectively.</p> Results <p>In total, 1739 patients (median follow-up of 51 [interquartile range 34–64] months) were included, of whom 1272 (73%) had disease recurrence.&#xa0;In these patients, recurrence-focused treatment&#xa0;was administered in 64/124 (52%) after FOLFIRINOX-based NAT compared with 74/410 (18%) with resection only (OR 4.13 [95% CI 3.34–5.12]; <i>P</i>&lt;0.001), 29/70 (41%) with gemcitabine-based NAT (OR 1.61 [95% CI 1.21–2.15]; <i>P</i>&lt;0.001), 239/604 (39%) with gemcitabine-based AT (OR 1.73 [95% CI 1.43–2.09]; <i>P</i>&lt;0.001), and 24/64 (38%) with FOLFIRINOX-based AT (OR 1.44 [95% CI 1.06–1.95]; <i>P</i>=0.02). Recurrence-focused treatment was associated with a median PRS of 11 (95% CI 10–13) months compared with 3 (95% CI 2–3) months in patients with best supportive care (HR 0.31 [95% CI 0.26–0.37]; <i>P</i>&lt;0.001).</p> Conclusions <p>Recurrence-focused treatment differs between patients with PDAC who received different primary treatment strategies and is associated with improved PRS.</p>

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Impact of Different Primary Treatment Strategies on Recurrence-Focused Treatment of Pancreatic Ductal Adenocarcinoma

  • 期刊论文

  • 发表日期：

    2025年11月7日

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  • Paul C. M. Andel,
  • Iris W. J. M. van Goor,
  • Thijs J. Schouten,
  • Marc G. Besselink,
  • Bert A. Bonsing,
  • Koop Bosscha,
  • Olivier R. Busch,
  • Geert A. Cirkel,
  • Ronald M. van Dam,
  • Sebastiaan Festen,
  • Bas Groot Koerkamp,
  • Erwin van der Harst,
  • Ignace H. J. T. de Hingh,
  • Martijn P. W. Intven,
  • Geert Kazemier,
  • Mike S. L. Liem,
  • Maartje Los,
  • Gert Meijer,
  • Vincent E. de Meijer,
  • Vincent B. Nieuwenhuijs,
  • Daphne Roos,
  • Jennifer M. J. Schreinemakers,
  • Martijn W. J. Stommel,
  • Fennie Wit,
  • Robert C. Verdonk,
  • Hjalmar C. van Santvoort,
  • I. Quintus Molenaar,
  • Lois A. Daamen,
  • Vincent P. Groot

摘要

Background

Increased application of neoadjuvant therapy (NAT) and adjuvant therapy (AT) could limit treatment options for pancreatic ductal adenocarcinoma (PDAC) recurrence. This study aimed to identify patterns of recurrence-focused treatment and survival following different primary treatment strategies.

Methods

All patients who underwent PDAC resection in the Netherlands (2014–2019) were included. Patients were divided into five groups according to their primary treatment strategy: (1) resection only, (2) gemcitabine-based NAT + resection, (3) FOLFIRINOX-based NAT + resection, (4) resection + gemcitabine-based AT, and (5) resection + FOLFIRINOX-based AT. Differences in recurrence-focused treatment and post-recurrence survival (PRS) were assessed using multivariable logistic and Cox-proportional hazards analyses and were presented as odds ratios (ORs) and hazard ratios (HRs) with corresponding 95% confidence intervals (95% CIs), respectively.

Results

In total, 1739 patients (median follow-up of 51 [interquartile range 34–64] months) were included, of whom 1272 (73%) had disease recurrence. In these patients, recurrence-focused treatment was administered in 64/124 (52%) after FOLFIRINOX-based NAT compared with 74/410 (18%) with resection only (OR 4.13 [95% CI 3.34–5.12]; P<0.001), 29/70 (41%) with gemcitabine-based NAT (OR 1.61 [95% CI 1.21–2.15]; P<0.001), 239/604 (39%) with gemcitabine-based AT (OR 1.73 [95% CI 1.43–2.09]; P<0.001), and 24/64 (38%) with FOLFIRINOX-based AT (OR 1.44 [95% CI 1.06–1.95]; P=0.02). Recurrence-focused treatment was associated with a median PRS of 11 (95% CI 10–13) months compared with 3 (95% CI 2–3) months in patients with best supportive care (HR 0.31 [95% CI 0.26–0.37]; P<0.001).

Conclusions

Recurrence-focused treatment differs between patients with PDAC who received different primary treatment strategies and is associated with improved PRS.