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Methods: We retrospectively analyzed resectable and borderline resectable PDAC patients who underwent pancreaticoduodenectomy (2010-2019) at a single institution. Optimal CA19-9 response was defined as normalization and> 50% reduction. We utilized Kaplan-Meier and multivariate-adjusted Cox models for statistical analysis. Overall survival (OS) was calculated from both diagnosis and surgery to account for the immortal time bias of receiving NAC.

Results: 488 patients were included in this study. The multivariate-adjusted analysis demonstrated OS benefit in the NAC group only when OS was calculated from diagnosis (HR= 0.77, p= 0.034), but not from surgery (HR= 0.89, p= 0.369). However, in 57 patients who achieved optimal CA19-9 response, OS is significantly longer than the 106 patients with suboptimal CA19-9 response (39.5 m vs 21.3 m, p= 0.004) or the 110 SF patients (39.5 m vs 20.1 m, p= 0 …