Journal Article

Adjuvant chemotherapy omission after pancreatic cancer resection: a French nationwide study

Poiraud, Charles, Bertrand, Nicolas, El Amrani, Mehdi, Lenne, Xavier, Theis, Didier, Bruandet, Amélie, Turpin, Anthony, Truant, Stephanie

2024

Overview

Background Adjuvant chemotherapy (AC) improves the prognosis after pancreatic ductal adenocarcinoma (PDAC) resection. However, previous studies have shown that a large proportion of patients do not receive or complete AC. This national study examined the risk factors for the omission or interruption of AC. Methods Data of all patients who underwent pancreatic surgery for PDAC in France between January 2012 and December 2017 were extracted from the French National Administrative Database. We considered “omission of adjuvant chemotherapy” (OAC) all patients who failed to receive any course of gemcitabine within 12 postoperative weeks and “interruption of AC” (IAC) was defined as less than 18 courses of AC. Results A total of 11 599 patients were included in this study. Pancreaticoduodenectomy was the most common procedure (76.3%), and 31% of the patients experienced major postoperative complications. OACs and IACs affected 42% and 68% of the patients, respectively. Ultimately, only 18.6% of the cohort completed AC. Patients who underwent surgery in a high-volume centers were less affected by postoperative complications, with no impact on the likelihood of receiving AC. Multivariate analysis showed that age ≥ 80 years, Charlson comorbidity index (CCI) ≥ 4, and major complications were associated with OAC (OR = 2.19; CI 95% [1.79–2.68]; OR = 1.75; CI 95% [1.41–2.18] and OR = 2.37; CI 95% [2.15–2.62] respectively). Moreover, age ≥ 80 years and CCI 2–3 or ≥ 4 were also independent risk factors for IAC (OR = 1.54, CI 95% [1.1–2.15]; OR = 1.43, CI 95% [1.21–1.68]; OR = 1.47, CI 95% [1.02–2.12], respectively). Conclusion Sequence surgery followed by chemotherapy is associated with a high dropout rate, especially in octogenarian and comorbid patients.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Adjuvant chemotherapy / Adjuvant treatment / Aged / Aged, 80 and over / Antimitotic agents / Antineoplastic agents / Cancer / Carcinoma, Pancreatic Ductal - drug therapy / Carcinoma, Pancreatic Ductal - pathology / Carcinoma, Pancreatic Ductal - surgery / Care and treatment / Chemotherapy, Adjuvant - methods / Chemotherapy, Adjuvant - statistics & numerical data / Comorbidity / Current Evidence and Future Directions in the Treatment of Colorectal Cancer / Deoxycytidine - analogs & derivatives / Deoxycytidine - therapeutic use / Diagnosis / Dosage and administration / Female / Follow-Up Studies / France - epidemiology / Gemcitabine / Hospital volume / Humans / Male / Medicine / Medicine & Public Health / Middle Aged / Pancreatectomy / Pancreatectomy - statistics & numerical data / Pancreatic adenocarcinoma / Pancreatic cancer / Pancreatic cancer surgery / Pancreatic Neoplasms - drug therapy / Pancreatic Neoplasms - pathology / Pancreatic Neoplasms - surgery / Pancreaticoduodenectomy - methods / Pancreaticoduodenectomy - statistics & numerical data / Patient outcomes / Postoperative Complications - epidemiology / Prognosis / Retrospective Studies / Risk Factors / Surgical Oncology / Survival Rate