Timing of adjuvant chemotherapy in patients with pancreatic ductal adenocarcinoma: A nationwide analysis
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Guidelines recommend a time to adjuvant chemotherapy (TTC) within 12 weeks after pancreatic ductal adenocarcinoma (PDAC) resection. The aim of this study to evaluate the association between TTC and clinical outcomes in patients undergoing PDAC resection in the Netherlands. METHODS: Patients undergoing upfront, macroscopically radical PDAC resection (2014-2019) in the Netherlands were included. Patients were stratified into receiving no adjuvant chemotherapy, TTC 0-6 weeks, TTC 6-12 weeks, and TTC ≥12 weeks. Multivariable cox and logistic regression analyses were used to assess the association between TTC and overall survival (OS), and between TTC and adjuvant chemotherapy completion. RESULTS: Of 1459 patients, 543 (37 %) did not receive adjuvant chemotherapy, while TTC was 0-6 weeks in 245 (17 %), 6-12 weeks in 612 (42 %), and ≥12 weeks in 59 (4 %) patients. TTC in weeks (HR 0.99, 95 %CI 0.97-1.01, P = 0.39) and different TTC groups were not associated with OS (TTC 6-12 weeks vs TTC 0-6 weeks: HR 1.06, 95 %CI 0.76-1.49, P = 0.72, TTC ≥12 weeks vs TTC 0-6 weeks: (HR 0.62, 95 %CI 0.32-1.21, P = 0.16). Adjuvant chemotherapy completion was associated with improved OS (HR 0.81, 95 %CI 0.51-0.98, P = 0.04). Compared to TTC 0-6 weeks, TTC 6-12 weeks was associated with adjuvant chemotherapy completion (OR 1.57, 95 %CI 1.33-1.84, P < 0.001), while TTC ≥12 weeks was not (OR 1.13, 95 %CI 0.85-1.51, P = 0.39). CONCLUSION: TTC in patients with upfront PDAC resection was not associated with survival, but TTC 6-12 weeks was associated with adjuvant chemotherapy completion. These findings support prioritizing postoperative recovery rather than pushing early adjuvant chemotherapy initiation.
Authors: P.C.M. Andel, I.W.J.M. van Goor, N.C. Biesma, L. Urban, M.G. Besselink, B.A. Bonsing, K. Bosscha, Olivier R. Busch, G.A. Cirkel, R.M. van Dam, C.H.J. van Eijck, S. Festen, B. Groot Koerkamp, E. van der Harst, I.H.J.T. de Hingh, M.P.W. Intven, G. Kazemier, H.W.M. van Laarhoven, M.S.L. Liem, M. Los, V.E. de Meijer, V.B. Nieuwenhuijs, D. Roos, J.M.J. Schreinemakers, M.W.J. Stommel, G. van Tienhoven, R.C. Verdonk, J. de Vos-Geelen, J.W. Wilmink, F. de Wit, M.L. Wumkes, V.P. Groot, H.C. van Santvoort, L.A. Daamen, I.Q. Molenaar
Institutions: University Medical Center Utrecht, St. Antonius Ziekenhuis, Utrecht University, Amsterdam UMC Location University of Amsterdam, Cancer Center Amsterdam, Leiden University Medical Center, Jeroen Bosch Ziekenhuis, Maastricht University Medical Centre, Erasmus MC, OLVG, Maasstad Ziekenhuis, Catharina Ziekenhuis, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Medisch Spectrum Twente, University Medical Center Groningen, University of Groningen, Isala, Reinier de Graaf Hospital, Amphia Ziekenhuis, Radboud University Medical Center, Tjongerschans
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,810
OpenAlex ID: W4415939188