The survival effect of neoadjuvant therapy and neoadjuvant plus adjuvant therapy on pancreatic ductal adenocarcinoma patients with different TNM stages: a propensity score matching analysis based on the SEER database

Adjuvant therapy (AT) and neoadjuvant therapy (NAT) are standard treatments for pancreatic ductal adenocarcinoma (PDAC) depending on the status of the disease. However, whether AT improves survival after NAT and radical resection in all TNM stages remains unclear. We utilized the Surveillance, Epidemiology, and End Results (SEER) database (2010–2019) for PDAC patients who underwent radical surgery and applied Pearson’s chi-square test, multivariate and univariate Cox regression, Kaplan-Meier plot, Log-rank tests, and propensity score matching (PSM) for analysis. Given PSM after enrolling 13,868 PDAC patients, significant differences in survival were identified between AT and neoadjuvant therapy plus adjuvant therapy (NATAT) (p = 0.023) as well as between NAT and NATAT (p In this retrospective cohort study, we demonstrated that patients harboring tumors in late TNM stages, including N2 resectable PDAC, might have better survival from NATAT, and that certain patients with M1 disease might still benefit from comprehensive systemic therapy and radical resection.辅助治疗（Adjuvant Therapy, AT）与新辅助治疗（Neoadjuvant Therapy, NAT）是胰腺导管腺癌（Pancreatic Ductal Adenocarcinoma, PDAC）的标准治疗方案，需根据疾病状态选择。然而，在所有TNM分期中，辅助治疗能否改善新辅助治疗联合根治性切除术后的患者生存率，目前仍不明确。我们利用2010-2019年的监测、流行病学与最终结果（Surveillance, Epidemiology, and End Results, SEER）数据库，纳入接受根治性手术的胰腺导管腺癌患者，并采用皮尔逊卡方检验（Pearson’s Chi-square Test）、单变量及多变量Cox回归分析（Univariate and Multivariate Cox Regression）、Kaplan-Meier生存曲线（Kaplan-Meier Plot）、对数秩检验（Log-rank Test）以及倾向得分匹配（Propensity Score Matching, PSM）开展数据分析。在纳入13868例胰腺导管腺癌患者并完成倾向得分匹配后，我们发现辅助治疗组与新辅助治疗联合辅助治疗（NATAT）组的生存率存在显著差异（p=0.023），新辅助治疗组与NATAT组的生存率差异同样具有统计学意义（原文此处p值未完整给出）。本回顾性队列研究证实，TNM分期较晚的患者（包括可切除N2期胰腺导管腺癌）或许可从NATAT方案中获得更优的生存获益，而部分远处转移（M1）患者仍可从综合系统治疗联合根治性切除术中获益。