Chemopreventive Agents After Pancreatic Resection for Ductal Adenocarcinoma: Legend or Scientific Evidence?
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ORIGINAL ARTICLE – PANCREATIC TUMORS
Chemopreventive Agents After Pancreatic Resection for Ductal Adenocarcinoma: Legend or Scientific Evidence? Domenico Tamburrino, MD, PhD1, Giovanni Guarneri, MD1, Michele Pagnanelli, MD1, Stefano Crippa, MD, PhD1,2, Stefano Partelli, MD, PhD1,2, Giulio Belfiori, MD1, Gabriele Capurso, MD, PhD3, and Massimo Falconi1,2 1
Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy; 2Vita-Salute San Raffaele University, Milan, Italy; 3Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
ABSTRACT Background. Pancreatic ductal adenocarcinoma (PDAC) is currently the fourth leading cause of cancer-related death in the USA. A wealth of evidence has demonstrated the chemopreventive activity of aspirin, statins, and metformin against PDAC. The aim of this study is to investigate the effect of aspirin, statins, and metformin on disease-free survival (DFS) and disease-specific survival (DSS) in a large population of PDAC patients undergoing pancreatic resection. Patients and Methods. All patients who underwent pancreatic resections between January 2015 and September 2018 were retrospectively reviewed. The potentially ‘‘chemopreventive agents’’ considered for the analysis were aspirin, statins, and metformin. Drug use was defined in case of regular assumption at least 6 months before
Domenico Tamburrino and Giovanni Guarneri have share first authorship. Gabriele Capurso and Massimo Falconi have share senior authorship.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09097-y) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 23 March 2020 Accepted: 16 August 2020 M. Falconi e-mail: [email protected]
diagnosis and regularly after surgery along the follow-up period. Results. A total of 430 patients were enrolled in this study, with median DFS and DSS of 21 months (IQR 13–30) months and 34 (IQR 26–52) months, respectively. On multivariable analysis, use of aspirin was associated with better DFS (HR: 0.62; p = 0.038). Metformin was associated with better DFS, without reaching statistical significance (p = 0.083). Use of statins did not influence DFS in the studied population. Aspirin, metformin, and statins were not associated with better DSS on multivariable analysis. Factors influencing DSS were pT3/pT4, N1, N2, no adjuvant treatment, G3, and ASA score [ 3. Conclusions. The results suggest that chronic use of aspirin is associated with increased DFS but not with better DSS after surgical resection in patients with PDAC.
Pancreatic ductal adenocarcinoma (PDAC) is currently the fourth leading cause of cancer-related death in the USA, with a 5-year survival rate of 8%.1 Surgical resection of early-stage d
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