Post-pancreatectomy chemotherapy improves the survival of patients with late-stage but not early-stage pancreatic cancer

Background: Although current clinical guidelines recommend that patients who have undergone surgical resection for pancreatic cancer consider adjuvant chemotherapy options, a significant proportion of pancreatic cancer patients undergo surgical resection without receiving adjuvant chemotherapy. One key factor that contributes to this phenomenon is the uncertain effectiveness of adjuvant chemotherapy across various disease stages. The objective of this study was to explore the influence of postoperative chemotherapy on the prognosis of patients with different stages of pancreatic cancer. Methods: We retrospectively analyzed the clinical data of 405 pancreatic cancer patients who underwent pancreatectomy between February 2016 and December 2020 in First Affiliated Hospital of Xi'an Jiaotong University. After excluding patients who did not undergo surgery, received other treatments, or died within 30 days postoperatively, 258 patients were included.96 received adjuvant chemotherapy and 162 did not. Early-stage (stage I, n=59) and late-stage (stages II-IV, n=199) were based on AJCC 8th edition. To minimize intergroup differences, propensity score matching (PSM) was performed. Overall survival (OS) was analyzed using the Kaplan-Meier method and Cox regression analysis. Results: Among the 258 patients, 187 died during follow-up, and the median survival was 14.9 months. Median follow-up was 36.5 months. In the overall cohort, patients receiving chemotherapy had longer median OS than those who did not (17.2 vs 13.3 months; P < 0.001). Chemotherapy significantly improved median survival in late-stage disease (15.6 vs. 11.9 months, P = 0.03), but not in stage I disease (28.0 vs. 27.0 months, P = 0.45). After propensity score matching, multivariable analysis confirmed that chemotherapy was independently associated with improved OS in late-stage disease (HR 0.59; 95% CI 0.38-0.91; P = 0.02). However, no significant survival benefit was observed in stage I patients (HR 0.69; 95% CI 0.27-1.77; P = 0.45). Conclusions: Patients with late-stage pancreatic cancer benefit from adjuvant chemotherapy after pancreatectomy. However, in patients with stage I pancreatic cancer, our data suggest that adjuvant chemotherapy may not confer a significant survival benefit.