Clinical to pathological staging differences for upfront surgery vs neoadjuvant therapy for pancreatic adenocarcinoma

Presenter: Omid Salehi MD | Saint Elizabeth's Medical Center Background: Inaccurate clinical staging of patients with pancreatic ductal adenocarcinoma (PDAC) may impact not only on prognostication but also treatment, resulting in chemotherapeutic and surgical over- undertreatment. This study assesses factors associated stage migration stratified by treatment sequence (i.e. upfront surgery (UFS) vs neoadjuvant therapy (NAT)). Methods: The National Cancer Database was searched for diagnosed I-III PDAC undergoing curative-intent between 2004-2016. Patients were sequence. Logistic regression used downstaging, upstaging, accuracy staging. Cox multivariable models Kaplan-Meier survival analyses performed to analyze the survival, migration. Results: 2466 met inclusion criteria; 2174 (88.2%) had UFS 292 (11.8%) NAT. 1523 (61.8%) no pathological stage, 850 (34.5%) upstaged, 93 (3.8%) downstaged. Overall 62.9%. When sequence, whereas NAT downstaging improved (HR 0.839, P=0.027). factor predicting disease (OR 17.155, P < .001), upstaging included advanced tumor grade, more recent year diagnosis, at an integrated cancer network. Factors decreased Asian/other race, size, government insurance, extent resection, Additionally, subgroup analysis vs. demonstrated be [P=0.019]. Conclusion: Although image quality is improving, continues underestimate II-III PDAC. inaccuracy affected quality, modifiable such as insurance status facility. As strongly a benefits (even if rare doesn’t occur), all resectable should considered