Survival benefit of recurrence-focused treatment after surgery for pancreatic ductal adenocarcinoma: A propensity score matched analysis of patients from a Dutch National and US institutional cohort

Background It is unclear whether recurrence-focused treatment (RFT) improves survival in all patients with recurrent pancreatic ductal adenocarcinoma (PDAC). This study aimed (1) to evaluate post-recurrence survival (PRS) in patients treated with RFT versus best supportive care (BSC)-only, and (2) to assess potential effect modification by prognosis at recurrence.Methods This observational cohort study included patients with local or distant recurrence after PDAC resection (2014-2022) at all Dutch pancreatic surgery centers and NYU Langone Health. Patients with unknown RFT or survival status were excluded. Prognosis at recurrence was defined using a previously established PRS risk score, stratifying patients into worse (≥174.5) and better (Results Overall, 1423 patients were included. After PSM, 344 RFT patients were matched to 344 BSC-only patients. The multivariable analysis included ECOG performance score and country as a random effect. PRS was 10 (95%CI 9-12) months for RFT versus 4 (95%CI 3-4) months for BSC-only (adjusted HR0.38, 95%CI: 0.30-0.48, P Conclusions Treatment for PDAC recurrence was associated with significantly longer PRS compared with BSC-only, irrespective of prognosis at recurrence. The survival benefit associated with RFT supports its consideration in the management of patients with PDAC recurrence.