Real-world patterns of adjuvant chemotherapy treatment for patients with resected pancreatic adenocarcinoma

Abstract

The aim of the study was to analyze the real-world treatment patterns of adjuvant chemotherapy administration among patients with resected pancreatic adenocarcinoma. Cases with non-metastatic pancreatic adenocarcinoma, diagnosed 2007–2018, treated with upfront surgical resection, and recorded within Alberta Cancer registry were accessed. Multivariable logistic regression analysis was conducted to evaluate factors predicting use of adjuvant chemotherapy. Kaplan–Meier survival estimates and multivariable Cox regression analysis were used to compare overall survival among patients treated with adjuvant gemcitabine versus those treated with adjuvant gemcitabine + capecitabine. A total of 695 patients who have undergone upfront surgical treatment of pancreatic adenocarcinoma, including 445 patients (64%) who received adjuvant chemotherapy and 250 patients (36%) who did not receive adjuvant chemotherapy. The following factors were associated with lower probability to receive adjuvant chemotherapy: older age (OR 0.94; 95% CI 0.93–0.96), node negativity (OR 0.47; 95% CI 0.33–0.67), higher Charlson comorbidity index (OR 0.86; 95% CI 0.74–0.99), and living within the Northern zone of the province (OR for Calgary zone versus North zone: 2.24; 95% CI 1.29–3.90). Within patients who received adjuvant gemcitabine ± capecitabine, factors associated with worse overall survival included higher Charlson comorbidity index (HR 1.18; 95% CI 1.00–1.40), and node-positive disease (HR for node-negative versus node-positive disease: 0.51; 95% CI 0.33–0.78). Type of chemotherapy was not predictive of overall survival (HR for gemcitabine versus gemcitabine plus capecitabine: 1.40; 95% CI 0.98–2.00). P value for interaction between type of chemotherapy and nodal status was 0.038. In this real-world study, the added benefit of adjuvant gemcitabine + capecitabine (compared to adjuvant gemcitabine) seems to be limited to patients with node-positive disease.

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Acknowledgements

The authors would like to thank the analytical teams at Surveillance and reporting and CancerControl Alberta for their help in data extraction.

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Correspondence to Omar Abdel-Rahman.

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Abdel-Rahman, O., Spratlin, J. & Koski, S. Real-world patterns of adjuvant chemotherapy treatment for patients with resected pancreatic adenocarcinoma. Med Oncol 38, 18 (2021). https://doi.org/10.1007/s12032-021-01469-y

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Keywords

  • Pancreas
  • Adjuvant chemotherapy
  • Survival
  • Prognosis