Assessment of Outcomes by Intention-to-Treat Comparison for Locally Advanced Pancreatic Cancer: A Population-Derived Cohort Study
Background The overall treatment response among patients with locally advanced pancreatic cancer (LAPC) is poorly understood as most studies report solely on resected patients. We aimed to investigate the outcomes in patients with LAPC as an intention-to-treat-analysis from the time of diagnosis fro...
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| Veröffentlicht in: | Annals of surgical oncology 2025, Vol.32 (1), p.508-516 |
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| creator | Larsson, Patrik Swartling, Oskar Cheraghi, Diana Khawaja, Ajnon Soreide, Kjetil Sparrelid, Ernesto Ghorbani, Poya |
| description | Background
The overall treatment response among patients with locally advanced pancreatic cancer (LAPC) is poorly understood as most studies report solely on resected patients. We aimed to investigate the outcomes in patients with LAPC as an intention-to-treat-analysis from the time of diagnosis from a complete source population.
Patients and Methods
An observational cohort study in a population-defined region within a universal healthcare system. All consecutive patients discussed at multi-disciplinary tumour board (MDT), aged ≥ 18 years and diagnosed with LAPC were included. Exposure was set as recommended treatment by MDT (i.e. upfront surgery, neoadjuvant therapy, palliative treatment or best supportive care). Outcome measures were overall survival analysed by Kaplan–Meier survival estimates and multivariable analyses using logistic regression for odds ratios (OR) and Cox proportional hazard analysis for hazard ratios (HR).
Results
In total, 8803 MDT events (6055 unique patients) with pancreatic disease were held during the study period. Some 1436 (24%) had pancreatic cancer, of which 162 (11%) had LAPC and 134 met the population-defined criteria. In overall survival analyses, the patients who were recommended neoadjuvant therapy (± surgery) demonstrated no significant difference to palliative chemotherapy (median 11.0 months vs. 11.8 months;
p
= 0.226). In multivariable analysis, adjusted OR for overall survival comparing the treatment groups was 0.27 (95% CI 0.02–3.29,
p
= 0.306) and Cox proportional HR 0.96 (95% CI 0.58–1.59,
p
= 0.865).
Conclusions
In patients with LAPC, survival was not statistically different between those recommended for attempt at neoadjuvant (± surgery) compared with those recommended palliative chemotherapy. The findings suggest that conversion/downstaging chemotherapy is successful in only a select few. |
| doi_str_mv | 10.1245/s10434-024-16291-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_886035</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3147279037</sourcerecordid><originalsourceid>FETCH-LOGICAL-c394t-e684ce04031c938c6186f42245e478b58bfc01418d0ffbd83e4541146e61aee03</originalsourceid><addsrcrecordid>eNp9kk1v1DAQhiMEoh_wBzggS1y4GDyx49hc0CoUqLRSK1HOluNM2pQkXuxk0R755zjdpVAOnGY088w79ujNshfA3kAuircRmOCCslxQkLkGqh9lx1CkkpAKHqecSUV1Louj7CTGW8ag5Kx4mh1xzWVRCH2c_VzFiDEOOE7Et-RinpwfMJJ6R87HKVU7P9LJ06uAdiKVHzY2dNGPpPWBrL2zfb8jq2ZrR4cNuUxhATtHqqUS3pEVufSbubd3Qh8wdNvEVf7Gh4l8meZm9yx70to-4vNDPM2-fjy7qj7T9cWn82q1po5rMVGUSjhkgnFwmisnQclW5OkOKEpVF6puHQMBqmFtWzeKoygEgJAowSIyfprRvW78gZu5NpvQDTbsjLedOZS-pQyNUpLxIvHv93zqDNi4dItg-wdjDztjd2Ou_dYAyELzclF4fVAI_vuMcTJDFx32vR3Rz9FwgHzZJcuEvvoHvfVzGNM9EiXKvNSML1S-p1zwMQZs718DzCyWMHtLmGQJc2cJo9PQy7__cT_y2wMJ4IfDpNZ4jeHP7v_I_gJSCcOQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3147279037</pqid></control><display><type>article</type><title>Assessment of Outcomes by Intention-to-Treat Comparison for Locally Advanced Pancreatic Cancer: A Population-Derived Cohort Study</title><source>MEDLINE</source><source>SWEPUB Freely available online</source><source>SpringerLink Journals - AutoHoldings</source><creator>Larsson, Patrik ; Swartling, Oskar ; Cheraghi, Diana ; Khawaja, Ajnon ; Soreide, Kjetil ; Sparrelid, Ernesto ; Ghorbani, Poya</creator><creatorcontrib>Larsson, Patrik ; Swartling, Oskar ; Cheraghi, Diana ; Khawaja, Ajnon ; Soreide, Kjetil ; Sparrelid, Ernesto ; Ghorbani, Poya</creatorcontrib><description>Background
The overall treatment response among patients with locally advanced pancreatic cancer (LAPC) is poorly understood as most studies report solely on resected patients. We aimed to investigate the outcomes in patients with LAPC as an intention-to-treat-analysis from the time of diagnosis from a complete source population.
Patients and Methods
An observational cohort study in a population-defined region within a universal healthcare system. All consecutive patients discussed at multi-disciplinary tumour board (MDT), aged ≥ 18 years and diagnosed with LAPC were included. Exposure was set as recommended treatment by MDT (i.e. upfront surgery, neoadjuvant therapy, palliative treatment or best supportive care). Outcome measures were overall survival analysed by Kaplan–Meier survival estimates and multivariable analyses using logistic regression for odds ratios (OR) and Cox proportional hazard analysis for hazard ratios (HR).
Results
In total, 8803 MDT events (6055 unique patients) with pancreatic disease were held during the study period. Some 1436 (24%) had pancreatic cancer, of which 162 (11%) had LAPC and 134 met the population-defined criteria. In overall survival analyses, the patients who were recommended neoadjuvant therapy (± surgery) demonstrated no significant difference to palliative chemotherapy (median 11.0 months vs. 11.8 months;
p
= 0.226). In multivariable analysis, adjusted OR for overall survival comparing the treatment groups was 0.27 (95% CI 0.02–3.29,
p
= 0.306) and Cox proportional HR 0.96 (95% CI 0.58–1.59,
p
= 0.865).
Conclusions
In patients with LAPC, survival was not statistically different between those recommended for attempt at neoadjuvant (± surgery) compared with those recommended palliative chemotherapy. The findings suggest that conversion/downstaging chemotherapy is successful in only a select few.</description><identifier>ISSN: 1068-9265</identifier><identifier>ISSN: 1534-4681</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-024-16291-9</identifier><identifier>PMID: 39365549</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adult ; Aged ; Cancer therapies ; Chemotherapy ; Cohort analysis ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Intention to Treat Analysis ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoadjuvant Therapy - mortality ; Oncology ; Palliation ; Palliative Care - statistics & numerical data ; Pancreatectomy ; Pancreatic cancer ; Pancreatic diseases ; Pancreatic Neoplasms - mortality ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - therapy ; Pancreatic Tumors ; Patient Outcome Assessment ; Patients ; Population studies ; Prognosis ; Surgery ; Surgical Oncology ; Survival ; Survival Rate</subject><ispartof>Annals of surgical oncology, 2025, Vol.32 (1), p.508-516</ispartof><rights>The Author(s) 2024</rights><rights>2024. The Author(s).</rights><rights>Copyright Springer Nature B.V. Jan 2025</rights><rights>The Author(s) 2024 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c394t-e684ce04031c938c6186f42245e478b58bfc01418d0ffbd83e4541146e61aee03</cites><orcidid>0000-0002-4726-6936</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-024-16291-9$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-024-16291-9$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,552,780,784,885,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39365549$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:159744506$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Larsson, Patrik</creatorcontrib><creatorcontrib>Swartling, Oskar</creatorcontrib><creatorcontrib>Cheraghi, Diana</creatorcontrib><creatorcontrib>Khawaja, Ajnon</creatorcontrib><creatorcontrib>Soreide, Kjetil</creatorcontrib><creatorcontrib>Sparrelid, Ernesto</creatorcontrib><creatorcontrib>Ghorbani, Poya</creatorcontrib><title>Assessment of Outcomes by Intention-to-Treat Comparison for Locally Advanced Pancreatic Cancer: A Population-Derived Cohort Study</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
The overall treatment response among patients with locally advanced pancreatic cancer (LAPC) is poorly understood as most studies report solely on resected patients. We aimed to investigate the outcomes in patients with LAPC as an intention-to-treat-analysis from the time of diagnosis from a complete source population.
Patients and Methods
An observational cohort study in a population-defined region within a universal healthcare system. All consecutive patients discussed at multi-disciplinary tumour board (MDT), aged ≥ 18 years and diagnosed with LAPC were included. Exposure was set as recommended treatment by MDT (i.e. upfront surgery, neoadjuvant therapy, palliative treatment or best supportive care). Outcome measures were overall survival analysed by Kaplan–Meier survival estimates and multivariable analyses using logistic regression for odds ratios (OR) and Cox proportional hazard analysis for hazard ratios (HR).
Results
In total, 8803 MDT events (6055 unique patients) with pancreatic disease were held during the study period. Some 1436 (24%) had pancreatic cancer, of which 162 (11%) had LAPC and 134 met the population-defined criteria. In overall survival analyses, the patients who were recommended neoadjuvant therapy (± surgery) demonstrated no significant difference to palliative chemotherapy (median 11.0 months vs. 11.8 months;
p
= 0.226). In multivariable analysis, adjusted OR for overall survival comparing the treatment groups was 0.27 (95% CI 0.02–3.29,
p
= 0.306) and Cox proportional HR 0.96 (95% CI 0.58–1.59,
p
= 0.865).
Conclusions
In patients with LAPC, survival was not statistically different between those recommended for attempt at neoadjuvant (± surgery) compared with those recommended palliative chemotherapy. The findings suggest that conversion/downstaging chemotherapy is successful in only a select few.</description><subject>Adult</subject><subject>Aged</subject><subject>Cancer therapies</subject><subject>Chemotherapy</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Intention to Treat Analysis</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy - mortality</subject><subject>Oncology</subject><subject>Palliation</subject><subject>Palliative Care - statistics & numerical data</subject><subject>Pancreatectomy</subject><subject>Pancreatic cancer</subject><subject>Pancreatic diseases</subject><subject>Pancreatic Neoplasms - mortality</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - therapy</subject><subject>Pancreatic Tumors</subject><subject>Patient Outcome Assessment</subject><subject>Patients</subject><subject>Population studies</subject><subject>Prognosis</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival</subject><subject>Survival Rate</subject><issn>1068-9265</issn><issn>1534-4681</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>D8T</sourceid><recordid>eNp9kk1v1DAQhiMEoh_wBzggS1y4GDyx49hc0CoUqLRSK1HOluNM2pQkXuxk0R755zjdpVAOnGY088w79ujNshfA3kAuircRmOCCslxQkLkGqh9lx1CkkpAKHqecSUV1Louj7CTGW8ag5Kx4mh1xzWVRCH2c_VzFiDEOOE7Et-RinpwfMJJ6R87HKVU7P9LJ06uAdiKVHzY2dNGPpPWBrL2zfb8jq2ZrR4cNuUxhATtHqqUS3pEVufSbubd3Qh8wdNvEVf7Gh4l8meZm9yx70to-4vNDPM2-fjy7qj7T9cWn82q1po5rMVGUSjhkgnFwmisnQclW5OkOKEpVF6puHQMBqmFtWzeKoygEgJAowSIyfprRvW78gZu5NpvQDTbsjLedOZS-pQyNUpLxIvHv93zqDNi4dItg-wdjDztjd2Ou_dYAyELzclF4fVAI_vuMcTJDFx32vR3Rz9FwgHzZJcuEvvoHvfVzGNM9EiXKvNSML1S-p1zwMQZs718DzCyWMHtLmGQJc2cJo9PQy7__cT_y2wMJ4IfDpNZ4jeHP7v_I_gJSCcOQ</recordid><startdate>2025</startdate><enddate>2025</enddate><creator>Larsson, Patrik</creator><creator>Swartling, Oskar</creator><creator>Cheraghi, Diana</creator><creator>Khawaja, Ajnon</creator><creator>Soreide, Kjetil</creator><creator>Sparrelid, Ernesto</creator><creator>Ghorbani, Poya</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0002-4726-6936</orcidid></search><sort><creationdate>2025</creationdate><title>Assessment of Outcomes by Intention-to-Treat Comparison for Locally Advanced Pancreatic Cancer: A Population-Derived Cohort Study</title><author>Larsson, Patrik ; Swartling, Oskar ; Cheraghi, Diana ; Khawaja, Ajnon ; Soreide, Kjetil ; Sparrelid, Ernesto ; Ghorbani, Poya</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c394t-e684ce04031c938c6186f42245e478b58bfc01418d0ffbd83e4541146e61aee03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Cancer therapies</topic><topic>Chemotherapy</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Intention to Treat Analysis</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy - mortality</topic><topic>Oncology</topic><topic>Palliation</topic><topic>Palliative Care - statistics & numerical data</topic><topic>Pancreatectomy</topic><topic>Pancreatic cancer</topic><topic>Pancreatic diseases</topic><topic>Pancreatic Neoplasms - mortality</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - therapy</topic><topic>Pancreatic Tumors</topic><topic>Patient Outcome Assessment</topic><topic>Patients</topic><topic>Population studies</topic><topic>Prognosis</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Larsson, Patrik</creatorcontrib><creatorcontrib>Swartling, Oskar</creatorcontrib><creatorcontrib>Cheraghi, Diana</creatorcontrib><creatorcontrib>Khawaja, Ajnon</creatorcontrib><creatorcontrib>Soreide, Kjetil</creatorcontrib><creatorcontrib>Sparrelid, Ernesto</creatorcontrib><creatorcontrib>Ghorbani, Poya</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Larsson, Patrik</au><au>Swartling, Oskar</au><au>Cheraghi, Diana</au><au>Khawaja, Ajnon</au><au>Soreide, Kjetil</au><au>Sparrelid, Ernesto</au><au>Ghorbani, Poya</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of Outcomes by Intention-to-Treat Comparison for Locally Advanced Pancreatic Cancer: A Population-Derived Cohort Study</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2025</date><risdate>2025</risdate><volume>32</volume><issue>1</issue><spage>508</spage><epage>516</epage><pages>508-516</pages><issn>1068-9265</issn><issn>1534-4681</issn><eissn>1534-4681</eissn><abstract>Background
The overall treatment response among patients with locally advanced pancreatic cancer (LAPC) is poorly understood as most studies report solely on resected patients. We aimed to investigate the outcomes in patients with LAPC as an intention-to-treat-analysis from the time of diagnosis from a complete source population.
Patients and Methods
An observational cohort study in a population-defined region within a universal healthcare system. All consecutive patients discussed at multi-disciplinary tumour board (MDT), aged ≥ 18 years and diagnosed with LAPC were included. Exposure was set as recommended treatment by MDT (i.e. upfront surgery, neoadjuvant therapy, palliative treatment or best supportive care). Outcome measures were overall survival analysed by Kaplan–Meier survival estimates and multivariable analyses using logistic regression for odds ratios (OR) and Cox proportional hazard analysis for hazard ratios (HR).
Results
In total, 8803 MDT events (6055 unique patients) with pancreatic disease were held during the study period. Some 1436 (24%) had pancreatic cancer, of which 162 (11%) had LAPC and 134 met the population-defined criteria. In overall survival analyses, the patients who were recommended neoadjuvant therapy (± surgery) demonstrated no significant difference to palliative chemotherapy (median 11.0 months vs. 11.8 months;
p
= 0.226). In multivariable analysis, adjusted OR for overall survival comparing the treatment groups was 0.27 (95% CI 0.02–3.29,
p
= 0.306) and Cox proportional HR 0.96 (95% CI 0.58–1.59,
p
= 0.865).
Conclusions
In patients with LAPC, survival was not statistically different between those recommended for attempt at neoadjuvant (± surgery) compared with those recommended palliative chemotherapy. The findings suggest that conversion/downstaging chemotherapy is successful in only a select few.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>39365549</pmid><doi>10.1245/s10434-024-16291-9</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-4726-6936</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2025, Vol.32 (1), p.508-516 |
| issn | 1068-9265 1534-4681 1534-4681 |
| language | eng |
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| source | MEDLINE; SWEPUB Freely available online; SpringerLink Journals - AutoHoldings |
| subjects | Adult Aged Cancer therapies Chemotherapy Cohort analysis Cohort Studies Female Follow-Up Studies Humans Intention to Treat Analysis Male Medicine Medicine & Public Health Middle Aged Neoadjuvant Therapy - mortality Oncology Palliation Palliative Care - statistics & numerical data Pancreatectomy Pancreatic cancer Pancreatic diseases Pancreatic Neoplasms - mortality Pancreatic Neoplasms - pathology Pancreatic Neoplasms - therapy Pancreatic Tumors Patient Outcome Assessment Patients Population studies Prognosis Surgery Surgical Oncology Survival Survival Rate |
| title | Assessment of Outcomes by Intention-to-Treat Comparison for Locally Advanced Pancreatic Cancer: A Population-Derived Cohort Study |
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