Impact of Neoadjuvant Therapy on Oncological Outcomes of Patients With Distal Pancreatic Adenocarcinoma

ABSTRACT Background Distal pancreatic ductal adenocarcinoma (D‐PDAC) often presents at an advanced stage. The efficacy of neoadjuvant therapy (NAT) in improving outcomes for D‐PDAC is not well‐established. This study evaluates the impact of NAT on the oncological outcomes of patients with D‐PDAC. Methods A retrospective cohort study of consecutive patients with resectable and borderline‐resectable D‐PDAC treated at a single center from 2012 to 2020 was performed. Stratification was based on initial treatment—NAT or surgery first (SF). Survival analysis, following intention‐to‐treat framework, used Kaplan–Meier and Cox regression to assess NAT's impact on progression‐free survival (PFS) and overall survival (OS) of D‐PDAC. Results Among 141 patients (median age 69.8 years, 51.8% females) included in the study, 71 (50.4%) received NAT and 70 (49.6%) were planned for SF. Patients receiving NAT were younger (65.9 vs. 72.6 years) and had higher incidence of borderline‐resectable disease (31% vs. 4.3%) (both p < 0.05) than those undergoing SF. Thirteen patients (18.3%) undergoing NAT and five (7.1%) in SF group, failed to undergo resection. Univariate comparison showed no difference in the PFS (SF:13.97 vs. NAT:17.00 months, p = 0.6), and OS (SF:23.73 vs. NAT:32.53 months, p = 0.35). Multivariate Cox regression analysis noted significantly improved PFS (HR = 0.64, 95%CI = 0.42–0.96, p = 0.031) and OS (HR = 0.60, 95%CI = 0.39–0.93, p = 0.021) with NAT. Conclusion NAT is associated with improved PFS and OS in patients with ‐D‐PDAC. Further randomized controlled trials are warranted to confirm these findings.