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- W2891638002 abstract "Background: The pattern, timing, and predictors of disease recurrence in patients who undergo neoadjuvant therapy followed by resection for pancreatic ductal adenocarcinoma (PDAC) have not been well established. Methods: We included patients who underwent pancreatectomy for PDAC at our institution between 2006 and 2014. Patients with incomplete or <24 months of follow-up were excluded. The first recurrence site was recorded. The overall survival (OS) and recurrence-free survival (RFS) were estimated from the date of surgery. Results: A total of 628 patients had detailed follow-up data available, 133 (21%) of whom had neoadjuvant therapy prior to resection. Median OS for the entire cohort was 23.8 mos. At a median follow-up of 22.1 mos, 515 (82%) of the 628 patients had recurred (median RFS 13.6 mos). Post-neoadjuvant patients recurred earlier after resection when compared to patients undergoing upfront resection (10.6 vs 14.6 mos, =0.008). The post-neoadjuvant cohort had higher rates of isolated local recurrence (43% vs 26%; <0.001), but lower rates of distant recurrence (42% vs 56%; =0.010). Post-neoadjuvant patients were less often lymph node positive (38%) after resection when compared to upfront resection (77%; <0.001). While lymph node status was an independent predictor for decreased RFS in the upfront surgery cohort, it did not predict disease recurrence in the post-neoadjuvant cohort. Patients receiving adjuvant chemotherapy or chemoradiotherapy had significantly fewer recurrences and a longer RFS in both the post- neoadjuvant and upfront cohort. Conclusion: Patients undergoing neoadjuvant therapy followed by pancreatectomy for PDAC were more likely to develop isolated local recurrence and had a shorter RFS than patients undergoing upfront resection. Furthermore, different factors predicted recurrence in these two distinct patient populations." @default.
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- W2891638002 date "2018-03-01" @default.
- W2891638002 modified "2023-10-16" @default.
- W2891638002 title "Differences in the pattern and timing of recurrence in patients after upfront or post-neoadjuvant pancreatectomy for pancreatic ductal adenocarcinoma" @default.
- W2891638002 doi "https://doi.org/10.1016/j.hpb.2018.02.370" @default.
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