Neoadjuvant Chemotherapy vs Surgery First in a Rural Population With Resectable Pancreatic Cancer: Oncologic, Biologic, and Socioeconomic Implications

BackgroundThe role of neoadjuvant chemotherapy (NAT) in patients with resectable pancreatic cancer is being studied in ongoing multicenter randomized trials. The primary aim of this study is to compare survival between NAT and up-front surgery (UFS) in a non-selected population of patients presenting with resectable cancer of the head of the pancreas. Patient and tumor-related factors impacting receipt of NAT and survival were also analyzed.MethodsA single institution prospective database was queried to identify patients who underwent pancreaticoduodenectomy for resectable pancreatic adenocarcinoma from 2019 to 2023. Patient demographic and clinical oncologic factors were compared between those who received NAT and those who underwent UFS. Area Deprivation Index (ADI) and distance traveled were used as surrogate indicators for socioeconomic disparity and rurality, respectively. Overall survival was compared using Kaplan-Meier and Cox Regression analyses.ResultsOf the 83 patients included, one third received NAT. There was no significant difference in 1 yr, 3 yr, or overall survival between patients who received NAT vs up-front surgery. ADI and distance traveled did not impact whether a patient received NAT or survival. On Multivariate Cox Regression analysis, age and performance status were the only factors significantly associated with survival.ConclusionsThere was no significant difference in early mortality and overall survival between NAT and UFS groups.