Survival benefits of neoadjuvant chemotherapy in advanced pancreatic cancer with vascular resection: who benefits the most? A study on key predictive factors

Neoadjuvant chemotherapy (NAC) is increasingly used for patients with borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC). However, its impact on survival after radical surgery with vascular resection remains unclear. This retrospective cohort study investigates the survival benefits of NAC and identifies key predictive factors. We analyzed data from a single-center cohort of patients between January 1, 2012, and December 31, 2022. Among 106 patients studied, thirty-seven underwent upfront surgery (UPS) and sixty-nine received NAC followed by surgery. We compared demographic, surgical, and pathological outcomes, using Kaplan-Meier analysis and Cox regression for survival analysis. The NAC group comprised a higher proportion of stage III patients and displayed substantial reductions in tumor size and lymph node metastasis. NAC improved overall survival (OS) (34.4 months vs. 22.0 months, p = 0.0038) and progression-free survival (PFS) (17.2 months vs. 7.1 months, p < 0.0001) compared to UPS. CA19-9 normalization, pathological lymph node status and tumor size, tumor regression grade 0-1 and adjuvant therapy were significant predictors of better OS. Age over 60 years, lack of CA199 normalization, and pathological N2 were significant risks factors of PFS. NAC is associated with improved survival outcomes in BRPC and LAPC patients undergoing radical surgery with vascular resection. Key factors influencing survival include CA19-9 normalization and tumor response to therapy. Further prospective studies are needed to confirm these findings.