A Calculator Approach to Select Neoadjuvant Therapy in Pancreatic Cancer
Menée à partir de données portant sur 1 426 patients atteints d'un adénocarcinome canalaire du pancréas résécable (âge médian : 69 ans), cette étude présente le développement d'un modèle, basé sur des facteurs pré-opératoires, pour prédire l'inutilité d'une pancréatectomie de première intention et identifier les patients nécessitant un traitement néoadjuvant
The treatment sequence in resectable pancreatic cancer remains a debate as randomized studies have not been able to show superiority of neoadjuvant therapy over up-front surgery. However, a subpopulation of patients will have a recurrence shortly after up-front resection and one may justifiably ask whether such an operation was futile. Further, from a health economical point of view, as pancreatic resection is an expensive procedure, futile operations are a significant waste of resources. Thus, accurately identifying an adequate patient population is of paramount importance.In this issue of JAMA Surgery, Crippa et al propose a preoperative MetroPancreas calculator model including American Society of Anesthesiologists (ASA) class, cancer antigen 19-9 (CA 19-9) serum levels, and radiological tumor size using a web-based calculator for personalized prediction of the risk for futile pancreatectomy in patients with anatomically resectable pancreatic cancer. In this observational study (1426 patients), the rate of futile pancreatectomy (death or disease recurrence within 6 months of the operation) was 18.9%. The model is suggested to help select patients for neoadjuvant therapy instead of up-front surgery.