Actual 5-year survival after neoadjuvant therapy and pancreatectomy: about one in three

Design

Retrospective two-centre cohort with complete follow-up

Population

660 patients resected after neoadjuvant therapy for localised PDAC, 2015 to 2021

Primary outcome

Actual 5-year survival from surgery

Effect

34.5% overall; 42.5% resectable, 29.0% borderline, 17.5% locally advanced

This retrospective study from two high-volume centres included 660 patients who had neoadjuvant therapy and curative-intent pancreatectomy for localised pancreatic ductal adenocarcinoma between 2015 and 2021, all with complete follow-up to death or five years. Published in Annals of Surgery in September.

Actual 5-year survival was 34.5%. Recurrence occurred in 74.1%, mostly early: nearly two-thirds of recurrences in patients who did not survive five years appeared within a year. Being recurrence-free at 1 and 2 years raised the chance of 5-year survival to 62.0% and 81.9%. Survival by stage at diagnosis was 42.5% resectable, 29.0% borderline and 17.5% locally advanced. Low comorbidity, CA19-9 below 200 U/mL, ypT0-1 and R0 resection predicted long-term survival.

Most published figures are actuarial estimates. Measured survival gives surgeons a truer number for consent and follow-up conversations. The selection is important: these are patients who completed neoadjuvant therapy and reached resection at expert centres, not all who started treatment.

• Quote about one in three patients alive at five years after neoadjuvant therapy and resection when consenting, adjusted for stage.
• Tell patients who are recurrence-free at two years that their outlook improves substantially (about 82% reached five years).
• Record baseline CA19-9, final ypT stage and margin status; each predicted long-term survival.
• Do not apply these figures to patients who start neoadjuvant therapy but never reach surgery.

Why it matters

Actual, not modelled, survival gives a more honest number for consent and surveillance planning.

Don't overread it

These are selected patients at high-volume centres who completed neoadjuvant therapy and reached resection.

The statistics, in plain English

Actual survival counts people known to be alive at five years; actuarial survival projects forward from incomplete follow-up and can overstate outcomes. Conditional survival — 81.9% (76 to 86%) for those recurrence-free at two years — is the chance of reaching five years given you have already come this far.

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