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

Medical Oncology volume 38, Article number: 18 (2021) Cite this article

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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  1. Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, T6G 1Z2, Canada

    Omar Abdel-Rahman, Jennifer Spratlin & Sheryl Koski

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  1. Omar Abdel-Rahman
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  2. Jennifer Spratlin
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  3. Sheryl Koski
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Correspondence to Omar Abdel-Rahman.

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Supplementary Information

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12032_2021_1469_MOESM1_ESM.png

Supplementary file 1 (PNG 96 KB) Supplementary figure-1: Overall survival according to receipt of adjuvant chemotherapy; a) among patients with node negative disease; b) among patients with node positive disease.

Supplementary file 2 (PNG 103 KB)

12032_2021_1469_MOESM3_ESM.jpg

Supplementary file 3 (PNG 56 KB) Supplementary figure-2: Overall survival according to type of adjuvant chemotherapy; a) among patients with node negative disease; b) among patients with node positive disease.

Supplementary file 4 (PNG 60 KB)

Supplementary file 5 (DOCX 14 KB)

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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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  • DOI: https://doi.org/10.1007/s12032-021-01469-y

Keywords

  • Pancreas
  • Adjuvant chemotherapy
  • Survival
  • Prognosis