Factors associated with mortality in pancreatic adenocarcinoma patients achieving pathologic complete response after neoadjuvant therapy

Introduction: Factors influencing mortality among pancreatic ductal adenocarcinoma (PDAC) patients who achieve pathologic complete response (pCR) following neoadjuvant therapy have not been previously well studied. Methods: Adult PDAC patients (2006-2021) who received neoadjuvant were identified in the National Cancer Database. Tumor response was categorized as pCR if final specimen was pT0N0. Patients with positive margins and stage IV disease were excluded. Results: Of 13,089 eligible patients, there were 207 patients who achieved pCR. The 3-year overall survival was 75% [69-81] for the entire cohort and did not differ significantly by clinical stage at diagnosis. Increased length of stay was the only factor associated with increased risk of mortality (HR 1.05 [95% CI: 1.02-1.09, P < 0.01]) in multivariable analysis. Conclusions: Among PDAC patients who achieve pCR, postoperative morbidity rather than initial disease stage appears to be the primary driver of long-term survival, informing prognostication for this unique subset of patients.