TY - JOUR
T1 - Timing of adjuvant chemotherapy in patients with pancreatic ductal adenocarcinoma
T2 - A nationwide analysis
AU - Andel, P. C.M.
AU - van Goor, I. W.J.M.
AU - Dutch Pancreatic Cancer Group
AU - Biesma, N. C.
AU - Urban, L.
AU - Besselink, M. G.
AU - Bonsing, B. A.
AU - Bosscha, K.
AU - Busch, Olivier R.
AU - Cirkel, G. A.
AU - van Dam, R. M.
AU - van Eijck, C.H.J.
AU - Festen, S.
AU - Groot Koerkamp, B.
AU - van der Harst, E.
AU - de Hingh, I. H.J.T.
AU - Intven, M. P.W.
AU - Kazemier, G.
AU - van Laarhoven, H. W.M.
AU - Liem, M. S.L.
AU - Los, M.
AU - de Meijer, V. E.
AU - Nieuwenhuijs, V. B.
AU - Roos, D.
AU - Schreinemakers, J. M.J.
AU - Stommel, M. W.J.
AU - van Tienhoven, G.
AU - Verdonk, R. C.
AU - de Vos-Geelen, J.
AU - Wilmink, J. W.
AU - de Wit, F.
AU - Wumkes, M. L.
AU - Groot, V. P.
AU - van Santvoort, H. C.
AU - Daamen, L. A.
AU - Molenaar, I. Q.
N1 - Publisher Copyright:
Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.
PY - 2026/1/1
Y1 - 2026/1/1
N2 - BACKGROUND: Guidelines recommend a time to adjuvant chemotherapy (TTC) within 12 weeks after pancreatic ductal adenocarcinoma (PDAC) resection. The aim of this study to evaluate the association between TTC and clinical outcomes in patients undergoing PDAC resection in the Netherlands. METHODS: Patients undergoing upfront, macroscopically radical PDAC resection (2014-2019) in the Netherlands were included. Patients were stratified into receiving no adjuvant chemotherapy, TTC 0-6 weeks, TTC 6-12 weeks, and TTC ≥12 weeks. Multivariable cox and logistic regression analyses were used to assess the association between TTC and overall survival (OS), and between TTC and adjuvant chemotherapy completion. RESULTS: Of 1459 patients, 543 (37 %) did not receive adjuvant chemotherapy, while TTC was 0-6 weeks in 245 (17 %), 6-12 weeks in 612 (42 %), and ≥12 weeks in 59 (4 %) patients. TTC in weeks (HR 0.99, 95 %CI 0.97-1.01, P = 0.39) and different TTC groups were not associated with OS (TTC 6-12 weeks vs TTC 0-6 weeks: HR 1.06, 95 %CI 0.76-1.49, P = 0.72, TTC ≥12 weeks vs TTC 0-6 weeks: (HR 0.62, 95 %CI 0.32-1.21, P = 0.16). Adjuvant chemotherapy completion was associated with improved OS (HR 0.81, 95 %CI 0.51-0.98, P = 0.04). Compared to TTC 0-6 weeks, TTC 6-12 weeks was associated with adjuvant chemotherapy completion (OR 1.57, 95 %CI 1.33-1.84, P < 0.001), while TTC ≥12 weeks was not (OR 1.13, 95 %CI 0.85-1.51, P = 0.39). CONCLUSION: TTC in patients with upfront PDAC resection was not associated with survival, but TTC 6-12 weeks was associated with adjuvant chemotherapy completion. These findings support prioritizing postoperative recovery rather than pushing early adjuvant chemotherapy initiation.
AB - BACKGROUND: Guidelines recommend a time to adjuvant chemotherapy (TTC) within 12 weeks after pancreatic ductal adenocarcinoma (PDAC) resection. The aim of this study to evaluate the association between TTC and clinical outcomes in patients undergoing PDAC resection in the Netherlands. METHODS: Patients undergoing upfront, macroscopically radical PDAC resection (2014-2019) in the Netherlands were included. Patients were stratified into receiving no adjuvant chemotherapy, TTC 0-6 weeks, TTC 6-12 weeks, and TTC ≥12 weeks. Multivariable cox and logistic regression analyses were used to assess the association between TTC and overall survival (OS), and between TTC and adjuvant chemotherapy completion. RESULTS: Of 1459 patients, 543 (37 %) did not receive adjuvant chemotherapy, while TTC was 0-6 weeks in 245 (17 %), 6-12 weeks in 612 (42 %), and ≥12 weeks in 59 (4 %) patients. TTC in weeks (HR 0.99, 95 %CI 0.97-1.01, P = 0.39) and different TTC groups were not associated with OS (TTC 6-12 weeks vs TTC 0-6 weeks: HR 1.06, 95 %CI 0.76-1.49, P = 0.72, TTC ≥12 weeks vs TTC 0-6 weeks: (HR 0.62, 95 %CI 0.32-1.21, P = 0.16). Adjuvant chemotherapy completion was associated with improved OS (HR 0.81, 95 %CI 0.51-0.98, P = 0.04). Compared to TTC 0-6 weeks, TTC 6-12 weeks was associated with adjuvant chemotherapy completion (OR 1.57, 95 %CI 1.33-1.84, P < 0.001), while TTC ≥12 weeks was not (OR 1.13, 95 %CI 0.85-1.51, P = 0.39). CONCLUSION: TTC in patients with upfront PDAC resection was not associated with survival, but TTC 6-12 weeks was associated with adjuvant chemotherapy completion. These findings support prioritizing postoperative recovery rather than pushing early adjuvant chemotherapy initiation.
UR - https://www.scopus.com/pages/publications/105024911358
U2 - 10.1016/j.ejso.2025.111165
DO - 10.1016/j.ejso.2025.111165
M3 - Article
C2 - 41314090
AN - SCOPUS:105024911358
SN - 0748-7983
VL - 52
JO - European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
JF - European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
IS - 1
M1 - 111165
ER -