Comparison of postoperative survival after neoadjuvant treatment versus upfront surgery in resected pancreatic ductal adenocarcinoma: a propensity score matching analysis.

PURPOSE: Evidence regarding long-term prognosis after surgery by pathological stage in pancreatic ductal adenocarcinoma (PDAC) patients following neoadjuvant treatment (NAT) remains limited. METHODS: 757 patients who underwent PDAC resection between 2017 and 2021 were analyzed retrospectively. Among them, 262 received NAT followed by surgery (NAT group) and 415 underwent upfront surgery (UFS group). Propensity score matching (PSM) was performed for balanced comparison using the following variables: age, sex, American Society of Anesthesiologists physical status class, and adjuvant treatment. RESULTS: After PSM, the UFS group showed higher postoperative CA 19-9, larger tumors, less advanced initial clinical stage, but more advanced pathological stage and fewer positive lymph nodes compared with the NAT group. Median overall survival (OS) was similar between groups (NAT vs. UFS: 35 vs. 34 months, P = 0.88). In stage IA, UFS patients had longer OS compared to NAT (not reached vs. 42 months, P = 0.037). No significant OS differences were observed at stages IB, IIA, IIB, and III. CONCLUSION: Postoperative survival did not differ between NAT and UFS groups when stratified by pathological stage, except for stage IA where UFS showed better outcomes.