Statistical cure fraction in patients with borderline resectable pancreatic ductal adenocarcinoma undergoing neoadjuvant therapy followed by radical resection: a secondary analysis of reconstructed individual patient data.

Purpose: Although neoadjuvant therapy (NAT) has been applied in patients with borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC), limited data on long-term outcomes are available to support its role as a potentially curable therapeutic option. This study assessed the probability of being statistically cured among these patients. Methods: The literature search was conducted focusing on previous studies that investigated the long-term recurrence-free survival rates of patients with BR-PDAC after NAT followed by radical resection. The reference cohort data were extracted from studies including patients undergoing upfront radical resection for resectable PDAC. Pseudo-individual patient data were reconstructed from the original papers. A non-mixture cure model was adopted to estimate the statistical cure fraction. Results: Twelve retrospective studies reporting long-term recurrence-free survival after NAT followed by radical resection for patients with BR-PDAC were secondarily analyzed. The probability of being statistically cured in these patients was 8.1% (95% confidence interval [CI], 5.4%-11.5%), which was lower than that of the reference cohort of 5 retrospective studies (14.7%; 95% CI, 13.2%-16.4%). There was a statistically significant difference between the 2 groups (hazard ratio, 1.110; 95% CI, 1.007-1.224). Conclusion: From this study, we concluded that a cure can be expected in around eight percent of patients with BR-PDAC after NAT followed by radical resection, which would be helpful in counseling patients, as well as deciding whether to perform the surgery.